The New York Provider ID Request Form is a document used by health care providers in the state of New York to apply for a Provider Identification Number (PIN). The PIN is a unique 8-digit number issued to eligible health care providers in the state of New York. This number is used to identify the provider when submitting claims to New York's Medicaid system. There are two types of New York Provider ID Request Forms: the First Time Request Form and the Reinstatement Request Form. The First Time Request Form is used by health care providers who are applying for a PIN for the first time. The Reinstatement Request Form is used by health care providers who need to reinstate their PIN after it has been canceled. Both forms require the applicant to supply personal and business information, including name, address, contact information, and tax identification number.
New York Provider ID Request Form
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How to fill out New York Provider ID Request Form?
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Effective September 22, 2022, the New York State (NYS) Medicaid fee-for-service (FFS) professional dispensing fee will change from $10.08 to $10.18 for covered outpatient drugs, when applicable.
A unique number assigned to each provider enrolled to provide services to members of the Medicaid program. This number is the primary method of identifying a provider.
Any inquiries regarding the enrollment process may be directed in writing to the Institutional Enrollment Unit of the Division of OHIP Operations, Office of Health Insurance Programs, New York State Department of Health, Suite 6E, 150 Broadway, Albany, NY, 12204-2736 or by telephone at (518) 474-3575 or (800) 342-3005.
For more information, call the Medicaid Helpline at 1-888-692-6116 or visit the NYS website.
Call the NY State of Health Customer Service Center at 1-855-355-5777 (TTY: 1-800-662-1220).
Getting Your Medicaid ID Number If you aren't sure what your Medicaid ID number is, you can get this information from Health and Human services either in-person or over the phone by providing them with your identifying information along with a photo ID.
Correspondence should be mailed to the following address, with the applicable P.O. Box from the table below: eMedNY P.O. Box Rensselaer, New York 12144- . The list of diagnosis codes is also available through publishing houses. 2.