Claims denied for non-enrolled providers
Enroll with the NYS Medicaid program to help avoid claim denials
Effective Sept. 1, 2022, we will deny all claims for providers who are not enrolled in the New York State Medicaid Program, regardless of their network status with UnitedHealthcare Community Plan of New York. Per the regulatory requirement, §5005(b)(2) of the 21st Century Cures Act and 42 CFR §438.602, the State of New York requires all Medicaid Managed Care (MMC) network furnishing, ordering, prescribing or referring providers to be enrolled with the New York State (NYS) Medicaid program.
As previously stated in the January 2018 Medicaid Update Newsletter (ny.gov), non-enrolled providers must enroll in the NYS Medicaid Program by Sept. 1, 2022, to avoid denial of claims.
Questions?
Reference the Medicaid Enrollment Requirements and Compliance Deadlines for Managed Care Providers article in the April 2022 Medicaid Update Newsletter for further details including:
- Information on how to enroll through eMedNY "Provider Enrollment and Maintenance" web page
- How to check your provider enrollment status on the NYS DOH “Medicaid Enrolled Provider Lookup” web page
