NYS Medicaid Provider Revalidation

Overview

Medicaid Provider Enrollment

To provide services to New York State (NYS) Medicaid members, enrollment as a Medicaid provider is required for providers in enrollable categories of service (provider types). This applies to providers billing Medicaid fee-for-service, network providers submitting claims to managed care plans, or providers who appear on claims as ordering, prescribing, referring, or attending (OPRA) providers. You can enroll at: Provider Services Portal (emedny.org).

Medicaid Provider Enrollment Revalidation

Consistent with 42 CFR § 455.414, the state Medicaid programs must complete revalidation of enrollment for all providers, regardless of provider type, at least every five years, including ordering or referring physicians or other providers. States also have the discretion to require revalidation on a more frequent basis.

What is provider revalidation?

Revalidation is a mandatory process to verify that a provider's enrollment information, credentials, and practice details remain accurate and compliant with state and federal requirements. To maintain active participation in the program, all Medicaid providers must revalidate their enrollment whenever requested by the NYS Medicaid program.

Why is this happening now?

Two things have changed this year: (1) New York State has completed a multi-year transition to the Provider Services Portal (PSP), a secure, centralized digital platform that replaces the legacy paper-based enrollment and revalidation process. The PSP was deployed in phases beginning September 2025, with paper-based processes formally discontinued as of May 2026, all enrollment and revalidation activities must now be completed through the PSP. (2) In April 2026, the Centers for Medicare & Medicaid Services (CMS) directed all states to implement comprehensive provider revalidation strategies, requiring every Medicaid-enrolled provider to be revalidated over the next 24 months. NYS commits to working with every provider to help them move to the new PSP system and complete the necessary revalidation process.

Does this mean I'm suspected of fraud?

No. Revalidation is a routine program integrity measure that applies to all providers enrolled in the Medicaid program. Being notified to revalidate, including under an accelerated timeline, does not indicate any suspicion of wrongdoing. It is a standard process to ensure enrollment records are current and accurate.

What's Changing

Submission via the Provider Services Portal

All revalidations are completed through the Provider Services Portal (PSP). The legacy paper-based process was discontinued in May 2026.

Risk-Tiered Revalidation Cycles

Revalidation cycles are risk-tiered:

  • High-risk providers: Revalidation required every 3 years
  • Moderate-risk providers: Revalidation required every 4 years
  • Limited-risk providers: Revalidation required every 5 years

What Can I Expect

All Providers (Regardless of Risk Level)

  • Verification of provider identity and credentials
  • Confirmation of practice location and contact information
  • National Provider Identifier (NPI) validation
  • Submission of all required documentation through the Provider Services Portal (PSP)

Limited-Risk Providers

  • Standard screening as outlined above
  • Revalidation required every 5-years

Moderate-Risk Providers

  • All limited activities + pre/post-enrollment site visit
  • Revalidation required every 4-years

High-Risk Providers

  • All limited activities + pre/post-enrollment site visit + finger printing background check for all owners 5% or more
  • Revalidation required every 3-years

In instances where a provider is also enrolled in Medicare, results from that screening may be utilized to satisfy certain enhanced screening requirements such as site visits or fingerprinting.

If you are unsure of your risk level, you will be notified of your designation and applicable requirements when you receive your revalidation notice.

National Provider Identifier (NPI Requirement)

Enrolled providers must have a National Provider Identifier (NPI). Providers currently enrolled without an NPI must obtain one before their next revalidation. Start your NPI application now.

Timeline & Phases

Provider Revalidation Schedule

The provider revalidation process will be implemented in phases. Providers will receive a notification via email and United States Postal Service mail when it is time for them to revalidate.

Phase Providers Affected Notification Timing
Phase 1 Phase 1 includes current high-risk providers , Durable Medical Equipment (DME) providers , and any providers that have not revalidated since the beginning of the COVID-19 Public Health Emergency. Notifications for this phase began in July 2026.

The regularly scheduled revalidation cycle for all provider types not mentioned in this chart will restart toward the end of this phase.		 July 2026
Phase 2 Phase 2 includes newly designated high-risk providers including Applied Behavior Analysis (ABA), Home and Community-Based Services (HCBS) under a 1915(c) Waiver, and Licensed Home Care Services Agencies (LHCSAs). Notifications for this phase will begin in Winter 2026. Beginning Winter 2026
Phase 3 Phase 3 includes atypical providers, specifically those who are currently enrolled without a National Provider Identifier (NPI). Notifications for this phase are scheduled for early 2027. Early 2027
Ongoing The ongoing phase will include all remaining moderate- and limited-risk providers. This process will continue through June 2028. Through June 2028

Exceptions to Revalidation

Certain enrollment transactions meet the same requirements as revalidation and, therefore, a revalidation notification would not be generated. An upcoming registration process in the Provider Services Portal will likely meet the revalidation requirement for many providers. In addition, a change of ownership, a reinstatement, or a category of service addition to a provider ID generally meets the requirements of revalidation.

How to Revalidate

To revalidate your provider enrollment, please visit: Provider Services Portal (PSP)

Enrollment Moratoriums

New York State is implementing temporary enrollment moratoriums for select provider classes. The provider classes impacted by the enrollment moratorium include:

  • Laboratory
  • Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
  • Applied Behavior Analysis (ABA)
  • Licensed Home Care Services Agencies (LHCSAs)
  • Pharmacy
  • Managed Long Term Care plans, including Managed Long Term Care Partial Capitation plans, Medicaid Advantage Plus plans, and Program of All-Inclusive Care for the Elderly (PACE) organizations

During the moratorium period, all pending applications, regardless of stage of review, will be discontinued effective immediately. This includes applications at any point in the review process, whether in initial submission, under active review, or awaiting final determination. No applications will be processed or advanced during the moratorium period. Applicants may (re)initiate an application following the conclusion of the moratorium. Existing enrolled providers in these classes are not affected and should continue to revalidate when notified.

Consequences of Non-Compliance

Failure to complete revalidation by the required deadline will result in termination of a provider's enrollment.

Frequently Asked Questions

  • How will I be notified? Notifications will be sent via email and physical mail. Please ensure your contact information is current in the PSP to receive these important notices.
  • What if I'm enrolled in both Medicare and Medicaid? Dually enrolled providers may have certain screening requirements, such as site visits, satisfied through Medicare. However, you are still required to complete your Medicaid revalidation with NYS Medicaid through the PSP.
  • What if I don't have an NPI? All providers must obtain an NPI before their next revalidation. You can apply for an NPI through the National Plan and Provider Enumeration System (NPPES). Providers who do not obtain an NPI will not be able to complete their revalidation and will have their enrollment terminated.
  • What does "high-risk" mean? Risk levels are assigned to provider categories and, at times, individual providers based on federal and state criteria. A high-risk designation means that provider type is subject to enhanced screening and more frequent revalidation. This designation does not indicate suspicion of fraud or malfeasance for an individual provider.
  • I'm a provider that delivers services only to managed-care members. Does this apply to me? Yes. All providers delivering services to NYS Medicaid members, or providers who order, prescribe, refer, and/or attend to NYS Medicaid members, must enroll in Medicaid, regardless of whether they provide services to managed care members, fee-for-service members or both. All Medicaid-enrolled providers are subject to revalidation requirements.

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