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  • Request For Participation As A Group Member - Form ... - Emedny - Emedny

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MAIL TO: Computer Sciences Corporation P.O. Box 4610 Rensselaer, NY 12144 REQUEST FOR MEDICAID PARTICIPATION AS A GROUP MEMBER Form must be completed in black ink. 1. Individual Provider Name: 2.

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Billing related questions can be directed to eMedNY at (800) 343-9000.

Licensed entities: Mail a copy of your updated license; approval documents from your state with an official letter requesting the change; copy of the new FEIN IRS letter and form 610501 to: eMedNY, PO Box 4610, Rensselaer, NY 12144-4610. Questions?

You may apply for Medicaid in the following ways: Through NY State of Health: The Official Health Plan Marketplace. Through a Managed Care Organization (MCO) Call the Medicaid Helpline (800) 541-2831. Through your Local Department of Social Services Office.

Step 1 (Required Unless Exempt) Obtain an National Provider ID (NPI) ... Step 2 (Required) Submit an Enrollment Application for Your Provider Type. ... Step 3 Application Review by NYS DOH. ... Step 4 Notification of Determination by NYS DOH. ... Step 1 (Required) Receive an ETIN.

Call Center at 1-800-343-9000 or click here to send us an email.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232