I am in a Medicaid plan's network. Do I still have to enroll with NYS Medicaid?

Yes. Under the 21st Century Cures Act, a provider in a New York managed care plan's network must also be enrolled directly with NYS Medicaid. Network membership and state enrollment are two separate steps, and finishing the plan contract feels like finishing both. It is one of the most common ways a New York claim gets denied for a reason nobody in the office recognizes.

Is Empire BlueCross BlueShield the same thing as Anthem now?

Yes. Empire BlueCross BlueShield downstate and Empire BlueCross upstate became Anthem Blue Cross and Blue Shield effective January 1, 2024, under Elevance Health. The networks and the contracts did not change with the name, so an existing Empire agreement is still live. Say Anthem when you apply, because paperwork addressed to Empire reads as out of date.

New York

New York Behavioral Health Credentialing: eMedNY, Medicaid Plans and Commercial Payers

Q: Do I have to enroll with New York Medicaid if I never bill Medicaid?

If you write prescriptions for anyone covered by New York Medicaid, yes. A prescriber who orders, prescribes, refers or attends without submitting claims enrolls as a non-billing OPRA provider on form EMEDNY-436901. Skip it and prescriptions you write for Medicaid members are not covered, including for members in managed care and HARP. Enrolling this way does not make you a Medicaid biller and does not oblige you to take Medicaid patients.

Q: What is HARP and do I need a separate contract for it?

HARP stands for Health and Recovery Plan. It is a product line for adults 21 and over with significant behavioral health needs, run by the same managed care companies rather than by a separate organization, and it wraps an enhanced behavioral health benefit around the same medical coverage, including Adult BH HCBS and CORE services. HIV Special Needs Plans are a further specialized line. Because HARP sits inside the plans, the question at contracting is whether your agreement includes the HARP line and those services. We ask each plan rather than assume.

Q: Does my UnitedHealthcare contract include Oxford?

Not automatically. Oxford Health Plans is separately incorporated inside UnitedHealthcare and is often the larger downstate commercial book across New York, New Jersey and Connecticut. A core UnitedHealthcare agreement does not necessarily include Oxford, so we confirm which one you actually hold. Behavioral health for both runs through Optum, started in Provider Express, and that single credential covers members on both books.

Q: Which New York plans should I start with?

It depends on the counties your patients live in, more than in most states. Fidelis Care is the only Medicaid Managed Care plan available in all 62 counties and is usually in the core set anywhere. In New York City the high-volume plans are typically Fidelis, Healthfirst and MetroPlusHealth. Upstate the regional plan for that market carries more of the book: Excellus across Central New York and the Finger Lakes, CDPHP in the Capital District, MVP across the Capital District and Hudson Valley, Independent Health around Buffalo.

Q: Do you need my CAQH password?

No, and we will not ask. We are added as an authorized practice manager, which lets us keep your practice data current and authorize each payer. You complete and attest your own profile and you sign your own paper applications. In New York that matters at six carriers at once, because Anthem, Aetna, Cigna, EmblemHealth, MVP and Excellus all work from CAQH and each one has to be authorized separately.

Two things in New York catch prescribers who did everything else right. eMedNY now runs new enrollment, reinstatement and maintenance through the Provider Services Portal, so older instructions point at a door that moved. And a prescriber who never bills Medicaid still has to enroll, on form EMEDNY-436901, or prescriptions written for Medicaid members aren’t covered. Then there’s the carve-out, which New York runs backwards from almost everywhere else.

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New York payers and timelines

The New York rule worth knowing

New York carved out the pharmacy, not behavioral health.

Behavioral health is usually the piece that gets handed to an outside vendor, and the drugs usually stay with the plan. New York’s Medicaid side runs it the other way. Behavioral health is delivered through the member’s own plan, mainstream Medicaid Managed Care or HARP, so there’s no behavioral health vendor standing in front of the carrier. Prescription drugs are what got carved out. Since April 1, 2023, drugs for MMC, HARP and HIV-SNP members bill to NYRx, the state’s fee-for-service pharmacy program, not to the plan.

Follow that to the end and you find who it hurts. Your visit settles with the plan. Your patient’s prescription settles with the State. So the State has to know who you are whether or not you ever send it a claim. A prescriber who only orders, prescribes, refers or attends enrolls as a non-billing OPRA provider on form EMEDNY-436901. Skip it and prescriptions you write for Medicaid members aren’t covered, and the first sign is a patient standing at a pharmacy counter with no idea why.

Being in a plan’s network doesn’t solve it. Under the 21st Century Cures Act a plan’s network provider must also be enrolled directly with NYS Medicaid, and signing the plan contract feels a great deal like finishing both. That enrollment has moved, too. New enrollment, reinstatement and maintenance now run through eMedNY’s Provider Services Portal, so instructions written before the change point somewhere else. It’s a quiet way to lose a month before anyone notices nothing was filed.

Credentialed›contracted›loaded›connected›payable

New York adds something outside those five boxes. Your visits settle with the plan and your prescriptions settle with the State, so being payable with a plan doesn’t mean the pharmacy side is clear. Only one of the two shows up in your remittances.

Two tracks

The State first. Then plans by region, on both sides of the house.

New York is unusually regional. Which Medicaid plans matter to you, and which Blue plan you need, are both decided by the counties your patients live in. On the Medicaid side the order isn’t a preference: a plan contract does very little until your state enrollment is active.

New York State Medicaid

One enrollment through PSP. Then the plans that serve your counties.

The Provider Services Portal is now the front door for new enrollment, reinstatement and maintenance, for every provider type. Individual practitioners, nurse practitioners included, enroll for individual billing. Affiliating to a group is optional and separate.

Which route you fileSubmit your own claims and you enroll as an individual billing provider. Only order, prescribe, refer or attend, and it’s the non-billing OPRA route on EMEDNY-436901. Either way, the plan contract is step two and never a substitute for the state file.

The plans, and they’re regional

Fidelis CareHealthfirstMetroPlusHealthUnitedHealthcare Community PlanMolinaAnthem HealthPlusMVPExcellusCDPHPIndependent Health

Who covers whereFidelis is the only one available in all 62 counties, and the state’s largest. Healthfirst runs the five boroughs, Long Island and the lower Hudson Valley. MetroPlusHealth is New York City only, a subsidiary of NYC Health + Hospitals. Molina is the former Affinity. Independent Health’s Western New York Medicaid product is MediSource.

HARP is a product line, not a companyHealth and Recovery Plans serve adults 21 and over with significant behavioral health needs, wrapping an enhanced benefit around the same medical coverage: Adult BH HCBS and CORE services. HIV Special Needs Plans are a further specialized line. Both live inside the plans above, so the contracting question is whether your agreement includes them.

Commercial

CAQH at nearly every carrier, then a different behavioral health door.

The national carriers work the same here as anywhere. What’s different is how much of New York’s commercial book sits with regional plans, and how the Blue license is split up.

Three Blue licensees, divided by regionAnthem, the former Empire, holds downstate and parts of upstate. Excellus holds Central New York, the Finger Lakes and Rochester, Utica and the Southern Tier. Highmark holds the far west and the northeast. Which Blue you need is a geography question before it’s a paperwork question.

Behavioral health has its own doorUnitedHealthcare and Oxford route to Optum, started in Provider Express, and one Optum credential reaches members on both books. Cigna routes to Evernorth. EmblemHealth’s GHI and HIP behavioral health runs through Carelon, and some Anthem behavioral health is administered by Carelon too, which we confirm per product rather than assume. Aetna keeps it inside the plan.

Oxford is not automatically includedOxford Health Plans is separately incorporated inside UnitedHealthcare and is often the larger downstate book across New York, New Jersey and Connecticut. A core UnitedHealthcare agreement doesn’t necessarily bring it with you. That’s a product distinction inside one carrier, not per-state fragmentation.

Seeing patients in other statesAetna, Cigna and UnitedHealthcare are national, so one contract each covers every state you’re licensed in, and one Anthem or Excellus contract reaches Blue members elsewhere through BlueCard where you hold a license. Joining another state’s Blue plan from New York is a different question, and some states want a physical presence first. Medicaid is the real exception, and New York Medicaid doesn’t travel.

New York commercial payers

Who you’ll apply to, and where behavioral health actually goes.

These are typical ranges from a complete application. Anthem, EmblemHealth and MVP each describe roughly 60 to 90 days under New York law, and Excellus states about 60 days on a completed one. Those are the carriers’ own statements of what they owe you, not a schedule we control, so we track and push rather than promise.

Anthem Blue Cross and Blue Shield

The former Empire. Downstate and much of upstate.

Usually: Anthem credentials from a complete CAQH application and its own materials often cite around 45 days. Recredentialing about every three years
The name: Empire became Anthem on January 1, 2024. Same networks, same contracts. Applications addressed to Empire read as stale
Reach: one New York contract reaches Blue members in other states through BlueCard where you’re licensed

Check first: some Anthem behavioral health runs through Carelon

UnitedHealthcare, with Oxford Health Plans

Two commercial books, one behavioral health door

Usually: 60 to 120 days from a complete application, with CAQH complete, attested and the plan authorized
The door: behavioral health credentialing runs through Optum in Provider Express, separate from core UnitedHealthcare and Oxford medical, and it covers members on both
Oxford: separately incorporated and often the bigger downstate book. A UnitedHealthcare agreement doesn’t automatically include it, so we confirm what you hold before filing anything

Separate door: Optum Behavioral Health

EmblemHealth

GHI and HIP. The downstate carrier out-of-state credentialers forget.

Who it is: GHI is EmblemHealth Plan, Inc. and HIP is Health Insurance Plan of Greater New York. Timelines vary by line
Why it matters downstate: strong in New York City public-sector and municipal groups, which can be a large slice of a Manhattan or Brooklyn panel
CAQH: complete, attested and EmblemHealth authorized. The medical contract doesn’t carry behavioral health with it

Separate door: Carelon Behavioral Health

Excellus BlueCross BlueShield

The upstate Blue

Usually: Excellus states that it credentials complete applications within about 60 days, citing New York public health and insurance law. Recredentialing and audits at least every three years
Footprint: Central New York, the Finger Lakes and Rochester, Utica and the Southern Tier
CAQH: complete, attested and Excellus authorized, with the required documents submitted alongside
Reach: one Excellus contract reaches Blue members elsewhere through BlueCard, and downstate Blue members are reached through Anthem the same way. This isn’t a contract per state

MVP Health Care

Capital District, Hudson Valley and northern New York

Order matters: MVP executes a Participation Services Agreement only after initial credentialing and primary source verification are finished, so the contract is the last step here rather than the first
Also Vermont: MVP operates on both sides of the border, and its Medicare and Medicaid lines are separate contracts from commercial
Confirm: which MVP networks apply where you practice, and how MVP administers behavioral health for that product

Cigna Healthcare

Behavioral health goes through Evernorth

Usually: up to about 90 days from a complete application
Right now the issue is the door, not the speed: Evernorth paused new individual and clinic behavioral health applications on June 1, 2026 and signaled a reopen after September 1. That pause is national, not a New York decision
Exceptions: facilities are exempt, and applications filed before June 1 still process

Separate door: Evernorth Behavioral Health

Aetna belongs in the usual New York opening set too, alongside Anthem, UnitedHealthcare, Cigna and EmblemHealth. It’s national, so one contract covers every state you’re licensed in, and it generally handles behavioral health inside the plan rather than through a separate vendor. Past those, whether a regional plan earns its paperwork is decided by your county rather than the plan’s size: CDPHP in the Capital District, Independent Health around Erie and Niagara, Highmark BlueCross BlueShield of Western New York. Each is its own contract and none of them travel. Medicare, and New York State Medicaid including the managed care and HARP lines, are scoped separately from a commercial package.

Carry a plan we didn’t list? Add it.

New York’s union health and welfare funds are large, and downstate they carry a real share of a working panel. The 1199SEIU National Benefit Fund is the one most people have heard of, with the 32BJ Health Fund and the NYC District Council of Carpenters funds behind it. TPA-administered self-funded plans and rented PPOs come up constantly too.

There’s no single answer for how you reach a Taft-Hartley fund. Sometimes it’s a rented commercial network you may already be in, sometimes a direct contract with the fund or its administrator, and behavioral health is occasionally carved to a separate vendor even when the medical side isn’t. Name the plan on the card and we trace the real route before anything gets filed.

What we need from you

Send these once and we can start.

You give us this in one intake. Then we fill out the applications. No passwords, no patient information, and nothing gets submitted until you’ve read it and signed.

Your individual NPIType 1 for you, plus the Type 2 if you bill under an entity. eMedNY enrolls individual practitioners for individual billing, and group affiliation is a separate step.
Active New York license and registrationeMedNY asks for proof of both, and every commercial application verifies it independently.
DEA certificate, if you prescribe controlled substancesNamed on eMedNY’s supporting document list. Tell us at intake if you don’t hold one.
CAQH attested, with each payer authorizedAnthem, Aetna, Cigna, EmblemHealth, MVP and Excellus all work from CAQH, and every one has to be authorized separately. You attest your own profile. We keep the data current and never ask for your password. Behavioral health for UnitedHealthcare and Oxford starts in Optum Provider Express instead.
Delegated eMedNY and PSP accessSo we can build and file your enrollment without sharing a password. The OPRA route runs through the same portal.
Malpractice certificateCurrent, with the coverage dates showing. It’s asked for on both sides of the house here.
Entity name, EIN, W-9 and EFT authorizationOne set per tax ID you bill under. EFT authorization is on eMedNY’s list, so Medicaid payment setup happens during enrollment rather than after.
Your ETIN, or the certification statement to get oneBilling New York Medicaid runs through an Electronic Transmitter Identification Number. A new enrollment or a new ETIN uses EMEDNY-490602; an existing ETIN uses EMEDNY-490601. Most people haven’t heard of it until the week they need it.

eMedNY’s supporting document list also includes a collaborating physician form where it applies to you. That’s enrollment paperwork and we prepare it like any other form. What New York asks of you clinically is a different subject, on the New York PMHNP scope of practice page.

One New York date we watch for you. Revalidation runs on the federal five-year cycle under 42 CFR 455.414, and New York ties it to your own enrollment anniversary rather than a calendar year, so there’s no shared deadline anyone reminds you about. It’s filed through PSP and the state’s notice is what starts it, so don’t file early. Do keep the address in your PSP file one you actually read. Missing a revalidation ends in termination, not a reminder.

Separately from your own license, New York can require the practice entity itself to hold an operating certificate from the Office of Mental Health under Mental Hygiene Law Article 31, with substance use programs on a parallel track through OASAS. The certificate attaches to a program and a site rather than to a clinician, and New York reviews an entity’s formation documents as part of the process. That’s why timing matters: it’s a far easier conversation before the entity exists than after. Whether a given New York practice sits inside or outside Article 31 is a genuinely open question, and not one we answer. We ask how you’re formed and what you plan to offer at intake, flag it early, and send you to OMH and your own counsel. We don’t publish the rules, tell you whether you need a certificate, or file it for you.

How it works

You answer once. We do the paperwork.

You can buy online without booking a meeting. Nobody has to sell you anything first.

Buy the package

Published price and scope. No call needed.

One intake

Short and guided. It asks more only where your answers call for it.

We prepare everything

Your eMedNY enrollment through PSP and every commercial application, filled out from what you told us.

You review and sign

Read it, change anything, sign. Nothing goes out until you say so.

We submit and track

You see what’s done, what’s waiting on a payer, and when you can bill.

What we commit to

Tracking is included. Every package comes with Command Suite access, so you can see where each payer application stands, what we are working on, what is waiting on a payer, and what we still need from you. You are not left guessing between the purchase and the finish.

If something we delivered does not work the way we said it would, we fix it at no charge for 30 days after delivery, including one stabilization review. That covers our own work. A new request, another payer or provider, or a change of scope is quoted separately.

Built to keep working after we are done. Everything we set up is built for the practice you are growing into, not only the one you have today. When the engagement ends you own the accounts, the documentation, and the systems, and they keep running without us.

Questions we get

New York credentialing questions

Do I have to enroll with New York Medicaid if I never bill Medicaid?

If you write prescriptions for anyone on New York Medicaid, yes. You’d enroll as a non-billing OPRA provider on form EMEDNY-436901, which covers ordering, prescribing, referring and attending. That puts you in the state’s file without making you a Medicaid biller. Skip it and prescriptions you write for Medicaid members aren’t covered, managed care and HARP members included. Cash-pay and commercial-only practices get caught by this constantly.

I’m already in a Medicaid plan’s network. Isn’t that enough?

No. Under the 21st Century Cures Act a provider in a New York managed care plan’s network must also be enrolled directly with NYS Medicaid. Two separate steps at two separate organizations, and signing the plan contract feels like finishing the job. The denial you get later doesn’t say “you skipped the state” in words anyone in a small office recognizes.

Where do I enroll now that eMedNY has changed?

New enrollment, reinstatement and maintenance for all provider types run through the eMedNY Provider Services Portal, the PSP. That’s what makes older material worse than merely dated: checklists and billing-company instructions written before the change point at the previous route. Individual practitioners including nurse practitioners enroll for individual billing, and group affiliation is an optional separate step.

Why does my patient’s prescription go to NYRx instead of their plan?

Because New York carved pharmacy out of managed care on April 1, 2023. Drugs for Medicaid Managed Care, HARP and HIV-SNP members bill to NYRx, the state’s fee-for-service pharmacy program, not the member’s plan. Your visit settles with the plan and the drug settles with the State. That’s why the State needs you in its file even when a plan already has you in its network.

What’s HARP, and do I need a separate contract for it?

HARP stands for Health and Recovery Plan: a product line for adults 21 and over with significant behavioral health needs, run by the same managed care companies rather than a separate organization. It wraps an enhanced behavioral health benefit around the same medical coverage, including Adult BH HCBS and CORE services. HIV Special Needs Plans are a further specialized line. So the contracting question is whether the agreement in front of you includes the HARP line, and we ask each plan rather than assume.

Is Empire BlueCross BlueShield the same as Anthem now?

Yes. Empire BlueCross BlueShield downstate and Empire BlueCross upstate became Anthem Blue Cross and Blue Shield effective January 1, 2024, under Elevance Health. The networks and contracts didn’t change with the name, so an existing Empire agreement is still live and doesn’t need redoing. Use Anthem when you apply, because paperwork addressed to Empire reads as out of date to the person opening it.

Does my UnitedHealthcare contract include Oxford?

Not automatically, and it’s worth checking before you assume downstate is covered. Oxford Health Plans is separately incorporated inside UnitedHealthcare and is often the larger commercial book across the New York, New Jersey and Connecticut metro. The behavioral health side is simpler than the medical one: Optum credentials it through Provider Express, and that single credential reaches members on both books.

Which New York plans should I start with?

It depends on your counties more than in most states. Fidelis is the only Medicaid Managed Care plan in all 62 counties and the state’s largest, so it’s usually in the core set anywhere. In New York City the high-volume plans are typically Fidelis, Healthfirst and MetroPlusHealth. Upstate the regional plan carries more of the book: Excellus across Central New York and the Finger Lakes, CDPHP in the Capital District, MVP across the Capital District and Hudson Valley, Independent Health around Buffalo. We map your real geography first, because filing broadly here mostly buys queue time.

Do you need my CAQH password?

No, and we won’t ask. We’re added as an authorized practice manager, which lets us keep your practice data current and authorize each payer. You complete and attest your own profile and sign your own paper applications. In New York that matters at six carriers at once, since Anthem, Aetna, Cigna, EmblemHealth, MVP and Excellus all work from CAQH.

Keep reading

New York PMHNP scope of practiceWhat New York allows you to do, which is a separate question from who pays you.
New Jersey payer enrollmentOutpatient behavioral health moved into the FamilyCare plans, so the panels moved with it.
Connecticut payer enrollmentMedicaid runs fee-for-service with no managed care plans to join at all.
Pennsylvania payer enrollmentBehavioral health is carved out county by county, and Highmark’s fast lane for advanced practice providers has a catch.
Opening your own practiceEntity, identifiers, payers, EHR and billing setup.
Adding a provider to your clinicFirst-time credentialing into contracts you already hold.
Changing your entity or tax IDMoving panels without breaking the money.
All 51 state guidesEvery state’s Medicaid path, plan roster and credentialing rules.

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Where this comes from

New York State Department of Health and eMedNY, provider enrollment: the Provider Services Portal now handles new enrollment, reinstatement and maintenance for all provider types, with provider-type guides and the supporting document list verified July 26, 2026
eMedNY, Ordering/Prescribing/Referring/Attending non-billing enrollment, form EMEDNY-436901 verified July 26, 2026
eMedNY, Certification Statement for Provider Billing Medicaid: EMEDNY-490602 for a new enrollment or new ETIN, EMEDNY-490601 for an existing ETIN verified July 26, 2026
eMedNY, managed care network providers must also be enrolled directly with NYS Medicaid under the 21st Century Cures Act verified July 26, 2026
eMedNY, revalidation at least every five years under 42 CFR 455.414, tied to the enrollment anniversary and filed through PSP verified July 26, 2026
New York State Department of Health, NYRx Medicaid Pharmacy Program, pharmacy carved out of managed care effective April 1, 2023 verified July 26, 2026
New York State Department of Health and the Office of Mental Health, Health and Recovery Plans and behavioral health under managed care, including Adult BH HCBS and CORE services verified July 26, 2026
New York State of Health, 2025 Medicaid Managed Care participation by issuer and county verified July 26, 2026
Anthem Blue Cross and Blue Shield (New York), the Empire rebrand effective January 1, 2024, join network and CAQH credentialing verified July 26, 2026
UnitedHealthcare and Optum, behavioral health joins through Optum Provider Express for United and Oxford members; and NewYork-Presbyterian’s payer listing, UnitedHealthcare and Oxford Health Plans operating together in New York verified July 26, 2026
Aetna, commercial credentialing and join network verified July 26, 2026
Cigna Healthcare and Evernorth, behavioral health credentialing and the June 1, 2026 application pause verified July 26, 2026
EmblemHealth, credentialing, and behavioral health through Carelon Behavioral Health for GHI and HIP verified July 26, 2026
Excellus BlueCross BlueShield and MVP Health Care, join network and credentialing for the upstate and Capital District carriers verified July 26, 2026
New York State Office of Mental Health, operating certificates under Mental Hygiene Law Article 31 verified July 26, 2026

Written by Ryan Berg, founder of AdvanceAPractice. 16 years in healthcare revenue cycle and credentialing.

Facts on this page were verified July 26, 2026 and are next due for review October 26, 2026.

Payer programs, plans and timelines change. Everything here carries a verification date and gets re-checked on a review cycle; this record is next due for review on October 26, 2026. Approval and effective dates are controlled by each payer and by the State, and credentialing commonly runs 60 to 120 days per payer. This page covers payer operations. It isn’t legal, tax or scope of practice advice.