One-On-One Appointment Registration Request

One-on-Ones

Representatives from eMedNY will be available to meet individually with the provider/provider staff to address Medicaid billing concerns. Appointments will last up to one hour.


If you answered Yes to one or more of these questions consider registering for a One-on-One appointment.

REGISTRATION FORM

You may register for a one-on-one appointment by completing the form below. All of the information below is required. Select a location and your preferred date and times and we will do our best to accommodate your preferences. After the form is submitted we will contact you to schedule your one-on-one session and provide you with additional appointment details.

Please Note: In order to allow sufficient time for each provider, no one will be seen without an appointment.

Provider Name: *
Provider MMIS ID or NPI: *
Contact Name: *
Phone Number: *
Email: *
Attendee Name(s): *
Select Your Region: *    click for region map
Preferred Date/Times: * OPTION 1
Date:
Time:
OPTION 2
Date:
Time:

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