DOH Starts Medicaid Provider Revalidation Process

(Aug. 11, 2026) The State Department of Health held a webinar on Aug. 6th to share its plan for revalidation of Medicaid providers.  The Centers for Medicare and Medicaid Services (CMS) is requiring all states to engage in this process as part of their initiative on combatting Medicaid and Medicare fraud.  The State has just initiated the process which will be carried out over a two year period.  Revalidation is a mandatory process to verify that a provider's enrollment information, credentials, and practice details remain accurate and compliant with state and federal requirements. To maintain active participation in the program, all Medicaid providers must revalidate or their Medicaid provider status will be revoked.

You can access the webinar slides here.

The revalidation process is not new.  However there are some new aspects to this process. DOH has a new paperless Provider Services Portal (PSP).  Deadlines for revalidating will be 45 days once a provider is notified. Providers will receive a notice by email and regular mail to revalidate.  We've heard that some communications are coming from Acentra, a contractor for DOH.  Please be diligent when reviewing emails for your revalidation notice.

Enrolled providers must have a National Provider Identifier (NPI). Providers currently enrolled without an NPI must obtain one before their next revalidation. Start your NPI application now.  Providers must also set up an ny.gov business account.

The Department is starting off revalidating high risk providers and providers who were not revalidated during the early months COVID-19.

DOH has three tiers of risk designation - high, moderate and limited - and will require pre/post visits for middle and high risk providers, as well as fingerprinting and background checks for high-risk providers.  Please note there are other scenarios which could bump a provider into the high risk category.  DOH shared that Applied Behavioral Analysis, 1915-C providers and Licensed Home Care Services providers are included in the high risk category.  

At CMS's urging, DOH has established provider moratoriums for several provider types:

• Laboratories

• Durable Medical Equipment

• Applied Behavioral Analysis

• LHCSAs

• Pharmacy

• Managed Long Term Care Plans (MLTC, MAP and PACE)

• Social Adult Day Care

The 6 month moratorium will prohibit Medicaid enrollment and change of ownership for providers in these categories. Managed Long Term Care plans will be implementing the moratorium for SADCs with more information to come on carrying out this requirement. 

LeadingAge New York members are already experiencing challenges with revalidation.  We are submitting a significant number of questions to DOH and urging some changes in their communications and processes. Please share with us any concerns or questions you may have so we can obtain appropriate clarifications from DOH. 

Members are urged to review all available resources to help prepare for revalidation. 

Resources & Contact

• NYS Medicaid Provider Enrollment's Office Hours: (For Individual Practitioners) - Mondays, from 12 PM - 1 PM EST. Click here to register. Submit Your Questions
• NYS Medicaid Provider Enrollment's Office Hours (For institutions, businesses, groups, and credentialers) - Thursdays, from 10 AM - 11 AM EST. Click here to register. Submit Your Questions
• Provider Services Portal (PSP) - Log In
• PSP Reference Materials & Guides
• NPI Application (NPPES)
• eMedNY Revalidation Resources (include PSP resources) https://www.emedny.org/info/ProviderEnrollment/
• DOH Web site page on revalidations: https://health.ny.gov/health_care/medicaid/integrity/provider_revalidation.htm

Contact: Meg Everett, meverett@leadingageny.org