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Submit Missing Participating Provider Owner/Manager Disclosure Certifications

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Submit Missing Participating Provider Owner/Manager Disclosure Certifications

10/17/2021

Our Enhanced Care Prime Network providers must have a Participating Provider Owner/Manager Disclosure Certification on file with us. This is a New York State Department of Health requirement for Medicaid-managed care participation. If you have an agreement that is missing this document, please take a few minutes to fill it out and submit the Certification online to ensure compliance.

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Join Our Network Disclosure Certification Assignment of Participating Provider Agreement to Health Insurance Plan of Greater New York (“HIP”)
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