Medical Credentialing Services in New York
Most providers assume a state medical board hands them their license. In New York, there is no standalone medical board that does that. Your physician license is issued by the New York State Education Department, through its Office of the Professions. That one fact catches a lot of new practices off guard, and it is a clue to how the rest of New York works: the pieces sit in places you would not expect, on different timelines, run by different offices.
That is the part we untangle. We provide medical credentialing services in New York for physicians, nurse practitioners, therapists, dentists, group practices and brand new practices, from the five boroughs of New York City out to Long Island and Westchester, and upstate to Buffalo, Rochester, Albany and Syracuse. You keep seeing patients. We run the portals, the applications and the follow up.
Who licenses you in New York, and why it surprises people
Here is the wrinkle. In most states a medical board issues the license. New York splits the job. The New York State Education Department (NYSED), through its Office of the Professions, is the body that actually issues your license. The State Board for Medicine sits inside NYSED and advises on standards, but it does not license you on its own. And if there is ever a conduct question, that goes to a different place again, the Office of Professional Medical Conduct at the New York State Department of Health.
Why does this matter to you? Because every payer application asks for proof of an active New York license, and they want it verified from the right source. We pull and document your NYSED licensure cleanly, watch the registration so it does not lapse, and keep that record ready for every enrollment we file.
What we handle for New York providers
New York runs Medicaid enrollment through eMedNY, and as the section above explains, licensing here does not sit where most providers expect. We connect both ends, eMedNY and the state's licensing route, to the commercial work so a New York file moves as one:
Tell us your specialty and market and we will scope it, or go straight to payer enrollment and provider credentialing.
New York Medicaid enrollment through eMedNY
New York Medicaid is run by the New York State Department of Health. The claims and enrollment side goes through eMedNY, the state system you use to apply, attest and manage your Medicaid provider record. Getting that record right the first time matters, because a kicked back application sends you back to the start of the queue.
Now the part people underestimate. New York Medicaid leans heavily on managed care, and being enrolled through eMedNY does not by itself put you in network with the plans your patients carry. The managed care and safety net plans, especially in New York City, each credential and contract on their own. We map the plans that matter for your patient mix and enroll you with each one.
Medicare runs nationally through PECOS and the CMS 855 forms. If you bill both, we sequence the Medicare and New York Medicaid work so one does not stall the other.
New York payers we enroll you with
Most New York practices need the big in state plans plus the national carriers. We enroll and contract you with:
We will also tell you straight whether a panel is open or closed in your area, instead of letting you sit on an application that was never moving.
How long credentialing takes in New York
Honest answer? It depends on the payer. Industry typical commercial credentialing runs about 90 to 120 days from a complete, clean file. New York Medicaid timelines through eMedNY vary, and because the managed care plans credential separately, the total can stretch when several plans are in play. The single biggest lever you control is a complete application with no gaps, and that is exactly where we earn our keep.
Working toward a start date? Tell us the date and we will tell you what is realistic, then build the plan backward from it.
Frequently asked questions
The major plans active in New York, including Healthfirst, MetroPlusHealth and Fidelis Care, EmblemHealth, Empire BlueCross BlueShield / Anthem, MVP Health Care, Excellus BlueCross BlueShield upstate, plus UnitedHealthcare and Oxford, Aetna and Cigna. Tell us your patient mix and we will map the panels that matter.
company-specific proof points — providers credentialed in New York, average turnaround achieved, years in business, New York office locations. phone
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*ProCred — national medical credentialing and payer enrollment for providers, groups and facilities across the United States.*