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eMedNY Update: Important Notice About Medicaid Revalidation of Managed Care Plans

The Situation Report | April 7, 2025

eMedNY, the electronic Medicaid Management Information System (MMIS) for New York State, used for processing Medicaid claims, verifying eligibility, and managing payments for healthcare providers has announced that federal regulation 42 CFR Section 455.414 requires states to periodically revalidate the enrollment of providers their Medicaid Programs, including providers enrolled as managed care plans under New York’s category of service 0220.  

On March 26, 2025, the state Department of Health (DOH) mailed written notification to most of the Medicaid Managed Care (MMC) plans in the state. The remaining managed care plans are scheduled to receive notification as they become due within the next nine months. All notifications are mailed to the correspondence address on the Medicaid enrollment file. 

To avoid negative downstream impacts, managed care plans must revalidate immediately upon receiving the notification. To begin the revalidation process, HCA plan members should:  

  1. Visit https://www.emedny.org, click on the Provider Enrollment tab at the top, and navigate to the Managed Care Plan option (found on the righthand side of the screen). From there, you can download the enrollment form, view the list of additional requirements/documentation for managed care plans, and determine whether an application fee is required. 
  2. Complete and mail the appropriate enrollment form, with all required additional forms and documentation, to the address found in the Mailing Instructions. DOH recommend that plans retain a copy of the submission for your records. 

After plans submit their revalidation, it generally takes two to three weeks for eMedNY to receive, prescreen, and forward your revalidation to the Department for processing. Revalidation submissions that are incomplete or do not contain required documentation will be rejected and returned to the correspondence address on the enrollment form. A letter will be mailed to your plan indicating the revalidation was successful once it has been successfully processed. 

HCANYS plan members with questions about revalidation can call the eMedNY Call Center at 1- 800-343-9000.