The New York Prior Approval Roster Request Form is a required document for certain Medicaid-funded services and programs. It is used to request prior approval from New York Medicaid to add providers to the Medicaid provider roster, or to make changes to existing providers already on the roster. The form is divided into two types: the New York Prior Approval Roster Request Form (PA-Roster) and the New York Prior Approval Relocation/Re-credentialing Request Form (PA-Relocation). The PA-Roster is used to add new providers to the Medicaid provider roster, while the PA-Relocation is used to update existing provider information due to a relocation or re-credentialing. Both forms must be completed and submitted for consideration.
New York Prior Approval Roster Request Form
State:
New York
Control #:
NY-BOP-700000
Format:
PDF
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Description
Prior Approval Roster Request Form
The New York Prior Approval Roster Request Form is a required document for certain Medicaid-funded services and programs. It is used to request prior approval from New York Medicaid to add providers to the Medicaid provider roster, or to make changes to existing providers already on the roster. The form is divided into two types: the New York Prior Approval Roster Request Form (PA-Roster) and the New York Prior Approval Relocation/Re-credentialing Request Form (PA-Relocation). The PA-Roster is used to add new providers to the Medicaid provider roster, while the PA-Relocation is used to update existing provider information due to a relocation or re-credentialing. Both forms must be completed and submitted for consideration.
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