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Credentialing services in New York
in New york
Provider credentialing and payer enrollment for independent New York practices. Qualigenix prepares, submits and follows up on every application with New York Medicaid, Medicare and commercial plans, and keeps each enrollment current after approval.
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How Qualigenix serves New York practices
Qualigenix handles provider enrollment for physician groups and solo practices across New York State through Qualigenix credentialing services. New York credentialing runs on several tracks at once. New York Medicaid enrolls providers through its online Provider Services Portal. Medicare enrollment goes through PECOS and National Government Services. Commercial and managed care plans each run their own credentialing, most of them using CAQH data. We work every track, for all payers, and report status for each payer as it moves. Payers make the final call on every application. Our job is to submit complete, accurate files and follow up until each payer decides. Because credentialing gaps show up as denied claims, we also tie enrollment to billing: Qualigenix runs medical billing for New York practices too, so a new provider's claims start the day the enrollment is active.
What credentialing services does Qualigenix provide in New York?
Qualigenix credentials individual providers and groups with New York Medicaid, Medicare and commercial payers. We collect documents, run primary source verification, manage CAQH profiles, submit payer applications, follow up until each payer decides, and handle revalidation and re-credentialing. Pricing is $99 per payer application.
We maintain high first-pass acceptance rates across all regional payers in New york.
New York credentialing problems we solve
Credentialing delays in New York usually come from four places: the state's Medicaid enrollment system, Medicare enrollment, commercial plan applications and license verification. Qualigenix works each one on its own timeline.
NY Medicaid Enrolment and Revalidation
Every provider who treats New York Medicaid members must be enrolled, including network providers who see only managed care members and the providers who order, refer or prescribe. Enrollment and revalidation now run only through the state's Provider Services Portal, and paper applications ended in May 2026. A new application must be submitted within 45 days of starting it, and a revalidation within 123 days of the notice. Qualigenix tracks both clocks, so a lapse never turns into denied Medicaid claims.
Medicare enrollment through PECOS
Medicare enrollment for New York providers runs through PECOS and is processed by National Government Services, the Medicare contractor for New York. Errors in practice location, reassignment of benefits or ordering and referring status hold up approval or leave Medicare claims unpaid later. Qualigenix prepares each PECOS application, links individual providers to the group correctly, answers contractor requests for information and tracks Medicare revalidation dates so enrollment doesn't lapse.
Commercial payer credentialing & CAQH kept current
New York requires managed care plans to decide on a provider's completed application within 90 days. Most commercial plans pull provider data from CAQH ProView, which must be re-attested every 120 days. Qualigenix re-attests every 90 days, keeps licenses, malpractice and board certifications current in the profile, and submits each plan's application. A complete file is what starts the plan's 90-day clock.
State license and board verification
The New York State Education Department's Office of the Professions licenses and registers physicians and most other health professions in the state. Physician misconduct cases are handled separately by the Department of Health. Qualigenix verifies each license, registration and board certification at the primary source, records expiration dates and reminds you before any of them lapse. Payers see a file that matches the state's records.
RESULTS ACROSS 275+ PRACTICES
Results New York practices can expect
These are company-wide figures across Qualigenix client practices, not New York-only results. Payers make every approval decision. These figures describe our part of the process.
12K+
Credentialing contracts managed
Up to 30% faster
Submission to approval
45-90 days
Payer approval window we work within
99%
Documentation & data-verification accuracy
Verification to NCQA and CMS standards
Verification standard
Managed on a 90-day cadence
CAQH re-attestation
Reported per payer
Status reporting
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ ClinicsGETTING STARTED
How onboarding works
Qualigenix credentials a New York provider in eight steps.
01
Document collection
We collect licenses, certifications, education, work history, malpractice coverage and NPI details.
02
Primary source verification
Each credential is verified at the primary source to NCQA and CMS standards.
03
CAQH profile setup
We build or update the provider’s CAQH ProView profile and set the re-attestation schedule.
04
Payer applications
Applications go to New York Medicaid, Medicare and each commercial plan you choose.
05
Contracts and participation
We confirm contracts and network participation once a payer approves.
06
Payer follow-up
Follow-up runs weekly or biweekly with every payer until each one decides.
07
Renewal tracking
Re-credentialing and revalidation dates are tracked from the first approval.
08
Status reporting
You get status reporting for each payer throughout.
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WHY PRACTICES CHOOSE QUALIGENIX
Why New York practices choose Qualigenix
Independent practices across New york partner with Qualigenix for consistent cash flow and high claim accuracy.
Priced per payer application
Credentialing costs $99 per payer application, covering full provider credentialing and payer enrollment. You know the cost before we start.
One credentialing specialist per account
One person owns your providers' files, payer contacts and deadlines, so nothing gets lost between staff.
Status reported for every payer
You see where each application stands with each payer, including what the payer asked for and when we answered.
Credentialing and billing in one company
Qualigenix also bills claims and runs full revenue cycle management. Enrollment dates go straight to billing, so new providers' claims go out the day they're active.
HAVE QUESTIONS?
Frequently Asked Questions
Frequently asked questions about our setup and support in New york.
Many credentialing firms work with New York providers, from national vendors to local consultants. Qualigenix is a US credentialing company serving providers in 48 states, including New York, and has managed 12K+ credentialing contracts. Talk to a credentialing specialist about your providers.
We prepare and submit each enrollment through New York Medicaid's Provider Services Portal, the only channel the state now accepts. We gather the documents first, submit inside the state's 45-day window and answer any follow-up from the state's enrollment staff.
Yes. Qualigenix prepares Medicare enrollment applications in PECOS for New York providers, which National Government Services processes. We also handle reassignment of benefits to your group and track Medicare revalidation dates.
Yes. We build and update CAQH ProView profiles and re-attest every 90 days, ahead of the 120-day requirement. Licenses, malpractice coverage and certifications stay current so commercial plans can pull a complete file.
Qualigenix works within a 45-90 day payer approval window and follows up weekly or biweekly with each payer. Payers make the final decision and set their own pace. New York requires managed care plans to decide on a completed application within 90 days.
Qualigenix charges $99 per payer application. That covers full provider credentialing and payer enrollment for that payer. Ask a credentialing specialist for a quote based on your providers and payer list.
Yes. We track re-credentialing cycles for commercial plans and revalidation dates for Medicare and New York Medicaid, then submit updated files before each deadline. That includes the revalidation notices New York Medicaid is sending through June 2028.
We follow up on a set schedule, find out what the payer needs and send it. If a payer goes quiet, we escalate through its provider relations channels. You see every step in your status report.