Did you know that more than 66 million individuals in the U.S. are enrolled in Medicare? Medicare is one of the largest insurance payers in the country, but becoming a Medicare-enrolled provider can be challenging.
Medicare credentialing in New York is an essential step for providers seeking reimbursement from Medicare. However, new providers may not understand the credentialing and enrollment process. Before we discuss the details, let’s take a step back and brush up on some basics.
Medicare provider credentialing and enrollment in New York is a multi-step, well-coordinated process. It is performed on the Provider Enrollment, Chain, and Ownership System (PECOS) nationwide. However, certain operational requirements and payer-specific processes may vary for New York providers.
Understanding Medicare NY Provider Enrollment
Provider credentialing and enrollment applications are processed by National Government Services (NGS). It is a Medicare Administrative Contractor (MAC) in New York with a regional office in East Syracuse.
Additionally, NY providers must also learn about the state’s parallel Medicaid enrollment requirements. The reason? They are tightly connected to Medicare status for providers seeking dual-eligible billing.
A large portion of the NY population is eligible for both Medicare and Medicaid (dual insurance), and NYS Medicaid is strictly enforcing a new rule:
Certain providers (including those billing DMEPOS and Medicare Part B services) must maintain active Medicare enrollment to participate in NYS Medicaid when applicable.
Simultaneously, NYS Medicaid is transitioning to a new Provider Services Portal (PSP) after which paper enrollment will be phased out entirely by July 2026.
Medicare NY Provider Enrollment & Credentialing Requirements
Medicare provider credentialing and enrollment in New York operate per the federal PECOS system. However, the application is routed to NGS, which processes it. NGS handles Medicare Jurisdiction K, which includes:
- Connecticut
- Maine
- Massachusetts
- New Hampshire
- New York
- Rhode Island
- Vermont
The following table covers all Medicare New York credentialing details:
| Element | Medicare New York Details |
|---|---|
| Standard Processing Time | Medicare enrollment usually takes 45-90 days through PECOS. Paper applications or incomplete submissions may take longer. |
| Revalidation Cycle | Most providers must renew (revalidate) their Medicare enrollment every 5 years. DMEPOS suppliers must revalidate their status every 3 years, as per the CMS schedule. |
| Required Medicare Enrollment Forms | CMS-855I: Individual providers (physicians and non-physician practitioners).CMS-855B: Group practices and organizations.CMS-855R: Reassignment of Medicare benefits. CMS-855S: DMEPOS suppliers. |
| Medicare Administrative Contractor (MAC) | National Government Services (NGS) is the Medicare Administrative Contractor for New York (Jurisdiction K) and processes both Part A and Part B enrollments. |
| MAC Office Location | East Syracuse, New York. |
| Medicare Enrollment System | Providers submit and manage Medicare enrollment through PECOS. |
| Application Fee (2026) | A $750 enrollment fee applies to institutional providers and DMEPOS suppliers. Physicians and non-physician practitioners are exempt from this fee. |
Note: The application fee may be subject to change in the future. Always review the latest fee schedule before advancing with the Medicare New York credentialing and enrollment.
NY Eligibility Requirements
The fundamental Medicare New York credentialing requirements are the same as those standardized on a federal level. Therefore, applicants must have:
- A valid, unrestricted New York State professional license.
- Appropriate state facility licensure from the New York State Department of Health (for institutional providers).
- Active Medicare program inclusions/ active OIG inclusions.
- A National Provider Identifier (NPI).
- Proof of malpractice insurance.
Medicare New York Credentialing Application Guidelines
Incomplete or mismatched information across PECOS and supporting documentation is one of the biggest reasons for credentialing denials. Fortunately, submitting a Medicare New York credentialing application correctly on the first attempt ensures you avoid this error.
However, getting credentialed with Medicare in New York is a step-by-step process, with each step holding great importance.
1. New York Licensure: Status and Restrictions
The provider must maintain an active license, and any disciplinary history may be reviewed during enrollment. If any discrepancies are found between license status and PECOS, NGS may request additional information from the applicant.
2. NPI Verification and Registration
Type 1 NPI is used for individual healthcare providers, while Type 2 NPI is used for organizations and group entities.
Notably, the National Plan and Provider Enumeration System (NPPES) NPI registry address and your New York practice location should be consistent and accurately reflect the provider’s enrollment details. If there is a discrepancy between the information on the NPPES and PECOS addresses, the application may be rejected.
3. PECOS Account Creation and Application Type Selection
A unique application type is applicable to each provider, and submitting the right one is necessary for smooth credentialing with Medicare New York.
Here is a breakdown of the application options each provider may use.
- CMS-855I for individual NY practitioners.
- CMS-855B for NY group practices and organizations.
- CMS-855R to reassign benefits to a NY group.
- CMS-855S if enrolling as a DMEPOS supplier.
4. Application Completion with NY Practice Location Details
Your practice location is a vital part of your Medicare New York credentialing. A complete application should have the following details:
- Practice address
- NY State license number
- Malpractice insurance carrier
- Coverage details
- Electronic Funds Transfer (EFT) information
5. Application Fee Payment (If Applicable)
New York State Medicare enrollment fee applies to each provider differently. Although individual practitioners do not have to pay a fee, DMEPOS suppliers still pay one. Similarly, institutional providers have to pay the fee set by CMS.
According to the current information, the fee is $750 for calendar year 2026, which can be paid directly via the PECOS fee payment portal.
6. Medicare New York Credentialing Application Submission & Tracking
Medicare New York credentialing application status can only be checked once all the required information is added and then submitted. You can track the application status directly in PECOS. However, if NGS requires more information or something particular, the applicant must comply.
Typically, applicants must respond to the NGS information request within 30 days. If this request is not answered promptly, the application will be denied and removed.
7. Complete Parallel NYS Medicaid Enrollment
Getting credentialed with Medicare New York can sometimes add more complexity. For instance, multiple NY providers must participate and enroll in both Medicare and NYS Medicaid. As of 2026, NYS Medicaid provider types generally use the Provider Services Portal (PSP) instead of paper forms.
What To Do in Case of Information Update/Changes?
According to CMS guidance, enrollment information must always be up-to-date. Otherwise, the applicant’s Medicare billing privileges may be revoked. When updating NY state Medicare provider enrollment information, providers must report the following changes within 30 days:
- Practice location changes
- Ownership changes
- Adverse legal action
All other enrollment updates must be reported within 90 days. If the applicant submits details via PECOS, the updates can be completed online. Conversely, if the information was originally provided via a paper application, a new paper enrollment form must be submitted to report changes.
New York State Medicare Enrollment & Credentialing Challenges
Providers in NY deal with several state-specific complications that may not be mentioned in generic Medicare credentialing guides. Here are some common challenges that NY providers may face:
Medicare Enrollment Compliance
Pharmacies seeking NYS Medicaid enrollment must maintain active Medicare enrollment when applicable. This may include CMS-855S enrollment for DMEPOS suppliers and, when applicable, CMS-855B enrollment for organizations. Pharmacies must also comply with DMEPOS supplier requirements, such as:
- Accreditation
- Liability insurance
- Surety bonds
- Supplier standards
Missing these requirements can result in loss of Medicare billing privileges and may impact Medicaid participation. While re-enrollment is possible, it may take a few months to complete.
Transition to the Provider Services Portal (PSP)
Provider enrollment and revalidation have transitioned from paper applications to PSP. PSP has been in use since late 2025, and paper enrollment applications are no longer accepted.
Notably, if providers use outdated forms or do not submit a complete online application on time, they may need to restart the enrollment process. These issues will directly delay payer approval and reimbursement.
Medicare and Medicaid Coordination of Benefits
Providers serving patients eligible for both Medicare and Medicaid (dual-eligible beneficiaries) must follow Coordination of Benefits (COB) requirements. Thus, Medicare should be billed first, followed by Medicaid.
If claims are submitted in an incorrect order, they may be:
- Denied
- Audited
- Subject to payment recovery
Moreover, active Medicare enrollment supports proper claim submission and timely Medicaid reimbursement.
Maintaining Medicare and Medicaid Enrollment
Medicare and NYS Medicaid providers must maintain current enrollment information through PECOS/NGS for Medicare and PSP for Medicaid. This may include updating information regarding changes to:
- Practice information
- Ownership
- Address
If the information is incorrect or inconsistent, it can:
- Affect enrollment status
- Delay provider communication
- Interrupt reimbursement
Streamline Medicare NY Credentialing & Enrollment with NeuraBill
Medicare credentialing in New York involves more than completing the PECOS process. Missing a single NY-specific requirement can delay the privileges. Whether it’s a DMEPOS Supplier Standard renewal or a PSP filing deadline, all rules must be followed.
Fortunately, NeuraBill’s provider enrollment services ensure New York providers are:
- Compliant,
- Credentialed,
- Reimbursed,
without interruption.
