![]() Check Reinstatement/Reactivation if the provider was previously enrolled but is not currently active.See Requirements and Additional Forms (below). Check Change of Ownership to comply with 42 CFR, Part 455.104 - Proof that a Change of Ownership has occurred is required.The Provider ID can be found on the Revalidation Letter you received Check Revalidation if the NPI or Provider is currently enrolled and you were notified that Revalidation is required per 42 CFR, Part 455.414.Check New Enrollment if the NPI or Provider listed is not currently enrolled in NYS Medicaid.0603 - Taxi (Upstate Taxi only), OR 0605 - Livery / Black Car (NYC only), OR 0606 - OPWDD Transport, OR 0609 - Transportation Network Company/High Volume for Hire Services Choose ONE Application Type and check the corresponding box on the Enrollment Form: ![]() If an ambulette provider submitted an application prior to December 1, they may reapply starting December 1. Previously denied applications will not be automatically processed. This supersedes the previous guidance and allows ambulette companies to enroll in Category of Service 0602 across all counties (contingent on the provider meeting other enrollment criteria). Under current Medicaid guidelines, potential Medicaid ambulette providers are denied enrollment in the Medicaid program when the proposed service will operate in New York City, and/or Nassau and/or Suffolk County as it has been determined by the New York State Department of Health that these locations have an adequate number of existing ambulette providers. Check Managed Care Only (Non Billing) - If the applicant/provider is contracted with a Managed Care and is required to enroll with NYS Medicaid per the 21st Century Cures Act.Ĭategory(s) of Service: Enter the applicable 4-digit code(s) on the Enrollment Form 0602 - Ambulette /Invalid Coach - non-medical, OR.Check Billing Provider - If the applicant/provider intends on Billing NYS Medicaid.Edit/Error Knowledge Base (EEKB) Search ToolĬhoose only ONE of the following options & check the corresponding box on the top of the Enrollment Form.National Diabetes Prevention Program (NDPP).Medicaid Managed Care Network Providers.Enrolled Practitioners SEARCH (including OPRA).
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