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- Being a provider in the MetLife Worldwide Benefits network means joining 215,000 direct pay providers in over 180 countries. Our members know that when they visit a preferred provider, they can expect quality care and seamless service.
- Managed Care Organizations (MCOs) can download this data set and use it to determine which providers are enrolled in Medicaid. MCO's and Providers can now view the.next anticipated revalidation date for any provider enrolled in NYS Medicaid.
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Provider Enrollment > Medicaid Managed Care Network Provider Enrollment
The 21st Century Cures Act requires all Medicaid Managed Care and Children's Health Insurance Program network providers to be enrolled with State Medicaid programs no later than January 1, 2018.
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If you received a letter from your Managed Care Organization stating that you have been identified as a provider who is not actively enrolled with the NYS Medicaid program and are providing services to their Medicaid eligible members, you must enroll or you will be removed from their Medicaid Managed Care provider network.
The Medicaid provider enrollment process is to ensure appropriate and consistent screening of providers and improve program integrity. In order to enroll, you will need to go to Provider Index and navigate to your provider type to print and review the instructions and enrollment form. Here, you will also find a Provider Enrollment Guide and How Do I Do It? resource guide. The Useful Links below includes, FAQs, and additional information related to the Medicaid Managed Care(MMC) network provider enrollment in New York State Medicaid.
Useful Links
Three previous data elements have been renamed (ex: MMIS ID has been changed to Medicaid Provider ID), please refer to the Data Dictionary-Change Log, Version 1.3 for further details. The change log will be available upon navigating to HDNY.
We added several new data elements as follows:
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We encourage Managed Care Organizations (MCOs) to review and become familiar with the updated layout and additional data elements.
The Medicaid Enrolled Provider Listing data set is now public on Health Data NY (see link below). This data set provides a listing of providers enrolled in Medicaid. Managed Care Organizations (MCOs) can download this data set and use it to determine which providers are enrolled in Medicaid.
- MCO's and Providers can now view the *next anticipated revalidation date for any provider enrolled in NYS Medicaid.
*Disclaimer: The Next Anticipated Revalidation date is subject to change based upon additional provider submitted application events that may occur. These are likely due to (but not limited to) a change of ownership, recently received or processed revalidation, reinstatement, etc.
Link to the Active data set: https://health.data.ny.gov/Health/Medicaid-Enrolled-Provider-Listing/keti-qx5t
The Medicaid FFS Pending Provider Listing has also been renamed to 'Medicaid Pended Provider Listing'. The Medicaid Pended Provider Listing reflects providers who have submitted an application to NYS, but a decision has not been made and they are not enrolled. Managed Care Organizations (MCO's) can review this data set to determine which providers have submitted applications but are not yet enrolled in Medicaid.
| MEDICAID PENDING PROVIDER LISTING | Last Modified: 02/08/2021 | MEDICAID PENDING PROVIDER LISTING - Text File |
MEDICAID PENDING PROVIDER LISTING DATA DICTIONARY | ||
- Managed Care Plan Sample Outreach letter to MMC network providers: DOC | PDF
- Quick Link back to the Provider Index Landing Page
In response to the COVID-19 pandemic, the Department is making every attempt to process enrollment applications as expeditiously as possible while balancing the health and safety of our employees. We ask for your patience as we work through them.
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If you have any questions about your enrollment, please contact the eMedNY call center at 800.343.9000. If your inquiry relates to a COVID-19 enrollment or maintenance issue, please send an e-mail to providerenrollment@health.ny.gov with 'COVID-19 Enrollment' in the subject line. Please include pertinent information (i.e., provider name, NPI, if applicable) and/or Enrollment Tracking Number, if known.