Provider Enrollment Application Fee

42 CFR, Part 455.460 requires the collection of an application fee for certain provider types and enrollment transactions. When navigating through the Provider Services Portal (PSP) you will be prompted if an Application Fee is required.

1. The fee is waived if you are enrolled in Medicare and/or another State's Medicaid Program or Children's Health Insurance (CHIP) Program or the Fee has been paid (at the current amount or previous amount) to Medicare. When prompted please select the appropriate option in the PSP, you may be prompted to also upload a form with additional information.

2. You may request a hardship waiver. Requests for hardship waiver should be sent with your enrollment form and should explain the hardship and justify the waiver, including explaining how your enrollment will ensure beneficiary access to services and supplying relevant business records. New York Medicaid will send your request to the Centers for Medicare & Medicaid Services (CMS) for review pursuant to Section 1866(j)(2)(C)(ii) of the Social Security Act. If the basis of your request is financial, you must include a balance sheet or other financial statement with your justification.