Join Online
Is the practitioner application right for you?
The online practitioner application is for individual practitioners who are not currently in the CDPHP network, but who wish to become participating providers.
To contract with CDPHP as a facility or ancillary provider, including laboratory services, durable medical equipment (DME), home health care, home infusion, transportation, imaging, dialysis, hospice, and skilled nursing, please contact Healthcare Network Strategy at (518) 641-4290.
Individual practitioners who are already credentialed with CDPHP® and are requesting an address/tax ID change or other demographic update should complete the Practitioner Information Change Request Form.
Requirements for in-network providers
- Maintain a physical practice location within the Health Plan’s geographic service area
- Have accessible locations to our members which may be subject to an office site visit conducted by the Health Plan
- Providers offering telehealth services only will not be credentialed or contracted with the Health Plan
How to apply
Step 1: Review these important documents – Practitioner Statement of Rights, Practitioner Qualifications, and Access and Availability Standards.
Step 2: Make sure your CAQH profile is up-to-date.
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CDPHP will review and verify your credentials, including your licenses, certifications, education, professional history, and your current W-9 using the Council for Affordable Healthcare (CAQH) ProView™ database.
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Prescribing providers must attach a copy of your current DEA certificate within CAQH
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For help creating or updating your CAQH profile, call CAQH at 888-599-1771.
Step 3: Apply for a New York MMIS number at the following NYS website:
The New York State Department of Health requires practitioners to have a NY Medicaid Management Information System (MMIS) ID number prior to enrollment with CDPHP Medicaid, HARP, or Child Health Plus (CHP). For questions regarding MMIS, contact Provider Services at (518) 641-3500.
Step 4: Complete the application, based on your practitioner type:
Step 5: Email the application and all required documents to provider.enrollment@cdphp.com. Please note a request to participate does not guarantee that you will receive a contract.
What’s Next?
As soon as we confirm your CAQH account and have signed provider contracts on file, we will begin the credentialing review. This process takes approximately 60 days, and you will receive written notification once the process is complete.