Verified October 10, 2026 against the statutes, regulations and sources cited below. General information, not legal advice. All states
What providers miss in New York
- Provisional credentialing covers only professionals joining a group that already participates; a solo applicant gets the 60-day clock but no provisional status.
- A provisionally credentialed physician cannot be named as a member's primary care physician until fully credentialed.
- Providers in Medicaid managed care can bring complaints to the Department of Health's Managed Care Complaint Unit without first using the plan's process.
Does New York have an any willing provider law?
No any willing provider law for medical providers was confirmed.
How long can a plan take to credential a provider in New York?
Within 60 days of a completed application, the plan must decide or tell the applicant that a third party has not supplied needed documents. It must then decide within 21 days of receiving them.
- Deadline: 60 days
- Applies to: Insurers and HMOs offering managed care products; all health care professionals
Citation: N.Y. Ins. Law 4803(a); N.Y. Pub. Health Law 4406-d(1)
Can a provider practice in network while New York plans credential them?
A newly licensed professional, or one newly relocated to New York, who joins a participating group is provisionally credentialed if the plan has not decided within 60 days. Physicians joining participating hospitals or certain clinics qualify too. The group must agree to refund in-network pay if the application is later denied.
- Provisional or interim credentialing
Citation: N.Y. Ins. Law 4803(a); N.Y. Pub. Health Law 4406-d(1)
What network adequacy rules apply in New York?
HMOs must keep networks adequate in number, location and type of provider, overseen by the Department of Health. Insurers whose plans include out-of-network coverage have separate adequacy duties.
Citation: N.Y. Pub. Health Law 4403(5); N.Y. Ins. Law 3241
Behavioral health credentialing parity
Insurers must run a compliance program so that credentialing documentation and qualifications for mental health and substance use providers are comparable to, and applied no more strictly than, those for medical and surgical providers.
Citation: 11 NYCRR 230.3(a)(4)(iv)
Will the New York insurance department take a provider complaint?
- New York State Department of Financial Services
Who oversees Medicaid managed care plans in New York?
- New York State Department of Health, Office of Health Insurance Programs
Turned down by a plan in New York?
We read the denial, check which of these rules reach that plan, and prepare the reconsideration request, the access-gap evidence and any regulator complaint the law supports; you sign and send them, and we track every deadline. Self-funded employer plans follow federal law, not New York's. A rejection review is $249, credited toward a dispute.
Sources
- credentialingDeadline, provisionalCredentialing
- credentialingDeadline.citation, provisionalCredentialing.citation
- networkAdequacy
- networkAdequacy
- credentialingDeadline (21-day rule), provisionalCredentialing (hospital-employed physicians), extras (11 NYCRR 230.3)
- insuranceDept (DFS Portal healthcare provider complaints: prompt pay, no-fault, workers compensation)
- medicaidAgency, notes (providers may complain to the Managed Care Complaint Unit)