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  • Group Enrollment Form - Emedny

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New York State Medicaid Enrollment Form Thank you for your interest in enrolling with the New York State Medicaid Program. As a Medicaid provider, you agree to comply with the rules, regulations and.

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367-b Questions & Answers

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Replace a lost, stolen, or damaged Medicaid card. If you make your request online or by phone it will take from 7 to 10 business days for you to get your replacement card. Replacement cards can only be mailed to the address on record.

If your Medicaid is with your Local Department of Social Service (LDSS), to order a new Medicaid Benefit Identification Card, please call or visit your LDSS. If your Medicaid is with the Marketplace (NY State of Health) and you need to order a new benefit card please call the call center at 1 (855) 355-5777.

Call the HRA Medicaid Helpline at 888-692-6116 for more information.

You cannot print a replacement card in New York, but will have to apply and then wait to receive your new Medicaid card in the mail.

You can also renew by calling New York State of Health at 1-855-355-5777 (TTY 1-800-662-1220) or visiting .nystateofhealth.ny.gov.

We encourage you to obtain an MMIS number as soon as possible by applying online or calling CSRA's (NYS' fiscal agent) eMedNY Call Center at 800-343-9000. MVP will notify you and provide you with a 60-day notice if you are being terminated from the MVP Medicaid Program due to not having an MMIS number.

Call the HRA Medicaid Helpline at 888-692-6116 for more information.

Enrollment questions may be directed to the Medicaid Enrollment Unit by telephone at 800-343-9000 or by email providerenrollment@health.ny.gov. MMC plan contact information can be found on the NYS DOH “New York State Medicaid Managed Care (MMC) Pharmacy Benefit Information Center” homepage.

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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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