Guidebook for Doula Enrollment in Medicaid
This guidebook provides a clear, actionable, 5 step process for doulas to enroll in Medicaid. Follow these steps closely for a successful application:
Welcome to your step-by-step Guidebook for Doula Enrollment in Medicaid! This resource is designed to walk you through each stage of the Medicaid enrollment process with ease, providing a clear path from applying for your National Provider Identifier (NPI) to submitting essential Medicaid provider forms. With this guide, you’ll feel confident and well-prepared to secure Medicaid approval, expanding your ability to offer essential, reimbursable care to clients who need it most.
This guide outlines the five core steps, helping you anticipate each requirement so you can gather documents and complete tasks smoothly. By following along, you’re just a few steps away from making a difference in more families’ lives by offering accessible, quality doula support. Ready to take your practice to the next level? Let’s get started!
Step 1:
Apply for a National Provider Identifier –NPI
- Access: https://nppes.cms.hhs.gov
Upon visiting the link above, locate and select the “Create or Manage an Account” button.
This initial step sets up your profile and allows you to access and manage essential Medicaid provider information.
Next, click “OK” to close the NPPES website pop-up. This will allow you to proceed with setting up your account without interruptions.
- User must select Accept to agree to the Terms and Conditions of the Identity & Access Management System
- One account will be created to access multiple systems. Select Create Account Now to proceed.
- Complete the User Registration fields.
- E-mail Address
- Confirm E-mail Address
- Captcha
- Click Submit
- Complete the User Registration –User Security fields
- User ID
- Password
- Confirm Password
- Proceed with answering the Five Security Questions and Answers
- Complete the User Registration – User Information fields
- Select Your address – You can either use:
- Select an authentication method
- Phone Number Text/SMS
- Email Address
- Phone Number Voice Call
- Once the MFA code is received via the selected authentication method, the user must enter a 6-digit code for verification.
- The Begin Alternative Setup option can be used to set up an additional form of MFA or the user can continue with the Complete Registration option.
- In the next step, you should see the user registration complete.
- Congratulations on completing the first step – You’ve now created an account in Identity & Access.
- Now, proceed with Signing Out of the Identity & Access Management System and return to NPPES.
For Future Sign In
- The next time You sign into I&A, You will be asked where you’d like to receive the verification code.
- Additionally, you’ll be asked if you are logging in from a public or private device.
- Public Device – MFA code will only verify access for that ONE session.
- Private Device: The system will install a cookie on the device, and the MFA is good for 24 hours.
Starting The Initial Application Process
- Once back at Nppes.cms.hhs.gov
- You can proceed to sign in under Registered User Sign In to begin the initial NPI application.
NPPES MFA Verification
- Upon signing in, the user will be presented with a page detailing MFA requirements for NPPES.
- For security reasons, NPPES needs to confirm your identity before continuing. Please request a verification code by clicking the send verification code button. This code will be sent to the email address you provided during registration.
- After the code is sent, the user must select the device type.
Initial Application – Myself
- Upon logging in with the I&A-established User ID and password, the user can select “Apply for an NPI for myself.“
- Applications are not required to be completed in one sitting. Users can save their progress and return to it later.
To resume an application in progress, click the pencil icon to navigate back to the last completed page.
- Users must provide both a Business Mailing Address and, at minimum, one Practice Location.
- Users must select the type of address that will populate the required fields for the Business Mailing Address.
- US Domestic
- Military
- Outside US / Foreign
Lastly, a checkbox to confirm: ’This is my home address’
- Accept Standardized Address – Accepts what is listed in the box on the right / Information may be different than was input.
- Use Input Address – Leaves the information that was input / Comments are required if using Input Address.
- Revalidate Address – Allows the user to modify information and NPPES will provide an address to accept.
Business Practice Location
- Accept Standardized Address – Accepts what is listed in the box on the right / Information may be different than was input.
- Use Input Address – Leaves the information that was input / Comments are required if using Input Address.
- Revalidate Address – Allows the user to modify information and NPPES will provide an address to accept.
- Once additional practice location(s) are added, the user must select one practice location as a Primary Location.
- The pencil or trash can be used at any point to edit or delete information that has been entered into the application.
Health Information Exchange – Endpoints
- Endpoints associated with a National Provider Identifier (NPI) are key components in secure healthcare information exchange. They allow verified healthcare participants to transmit and receive encrypted, authenticated health data directly with known and trusted parties.
This system enables smooth information exchange between various healthcare providers, (primary care physicians, specialists, hospitals, labs, etc.).
- Select Endpoint Type:
- Input the Endpoint:
- Select Yes or No to – Is the provider affiliated with another organization?
- If Yes, the user must select Choose Affiliation and look up the organization using either the NPI, full EIN, or LBN. Search Results will show below the search bar
To proceed:
- Please select the appropriate affiliated organization LBN from the search results by clicking Select next to it.
- Choose the corresponding Endpoint Location using either the drop-down menu or by clicking Add New Endpoint Location.
- If adding a new location, the Endpoint Location Address field will appear. Enter the address, and the system will automatically standardize it.
- Click the Save button to confirm your changes.
- If information is entered on this page, the user is required to check the acknowledgement box before saving.
Taxonomy
At a minimum, one Taxonomy Code and License (if applicable) must be entered on this page. ***15 Taxonomy Codes may be listed at MAX** All taxonomy codes available within the NPPES system may be found in the Choose Taxonomy: dropdown
- The Choose Taxonomy Filter can also be utilized to filter by taxonomy name or taxonomy code.
- Once the taxonomy code(s) and license(s) are added to the application, one taxonomy code must be identified as being the Primary Taxonomy.
Select the checkbox to the left of the applicable taxonomy code.
- If only one taxonomy code has been entered into the application, NPPES will default to this taxonomy code as the primary taxonomy.
Contact Information
For Contact Person Information, there are two options for identifying the contact:
- Provider – info will auto-fill from Provider Profile page
- 2nd individual – should be knowledgeable of NPPES/NPI
This is where the NPI will be sent once enumerated. Additionally, this contact person will be reached if any verification is required during the application process.
Note: Information remains private and is not displayed on the NPI Registry.
- Multiple Contact People can be added by selecting the ADD ANOTHER CONTACT button on the Contact Information page.
- One Contact Person must be selected as the Primary Contact.
Error Check – No Errors
Submission Confirmation
Step 2:
Gather Relevant Pathway Documentation
FORM REQUIREMENTS FOR TRAINING PATHWAY:
- Print a copy of your doula training certificate(s).
- If your doula training organization does not issue a certificate of completion, you may substitute it with a signed and dated letter on the organization’s letterhead.
- The letter must confirm that you have completed a doula training course.
FORM REQUIREMENTS FOR WORK EXPERIENCE PATHWAY:
Complete and print three Doula Client and/or Professional Recommendation Forms – (form 433403).
These forms must be completed by three different individuals.
Step 3:
Complete the Medicaid provider enrollment form using the template shown as a guide
General Instructions for the Enrollment Form
- Complete ALL items on the form unless otherwise instructed below. Failure to complete all required fields will result in your enrollment form being returned to you which may have an impact on the enrollment effective date.
- Required documents must be valid on the application date and continuously valid through the current date.
- An original signature is required. Initials or rubber-stamped signatures will not be accepted.
- Type or legibly print in black or blue ink. Do not use red ink or white-out. All attachments will be scanned so they must be legible and on standard 8.5 x 11 paper in good condition.
- Keep a copy of all documents submitted, as requests for copies cannot be honored.
- Valid telephone numbers are required for each service address.
- Do Not submit documentation containing recipient information with your application (e.g., paper claims forms, recipient insurance verification documents, etc.).
Additional Instructions for the Enrollment Form
For step-by-step guidance on completing the enrollment form, please view the Doula Sample Practitioner Enrollment Form.
Category(s) of Service: Enter the applicable 4-digit code(s) on the Enrollment Form 0464
Choose ONE Application Type and check the corresponding box on the Enrollment Form:
Check New Enrollment if the NPI or Provider listed is not currently enrolled in NYS Medicaid.
Check Revalidation if the NPI or Provider is currently enrolled and you were notified that Revalidation is required per 42 CFR, Part 455.414. The Provider ID can be found on the Revalidation Letter you received.
Check Reinstatement/Reactivation if the provider was previously enrolled but is not currently active.
Please Note: You will be at financial risk if you render services to Medicaid beneficiaries before completing the enrollment process.
NPI: This field is required.
DEA Number & Dates: N/A
License: Leave Blank.
Type of Practice: In the service address field Check the box, Individual (1) from the list.
Place of Service: Enter your office or home address (if NO primary office is available) per DOH Policy, then check the box that best describes the site (If applicable).
Association Types: Enter the letter (B, F, H, I, M, P, or U) that best corresponds to the individual’s role.
Note: To streamline your application and ensure all NDPP service providers are verified, list all lifestyle coaches for your organization in Section 5 of the application. Select either ‘I-Employee’ (Internal Employee) or ‘Lifestyle Coach’ (External/Contracted Coach) for each individual to categorize them correctly.
Requirements and Additional Forms
Required Forms
Doula Client and Professional Recommendation Forms – form #433403 for Work Experience Pathway only.
Doula Attestation Form – form #433402 Required for all Doula applicants: Work Experience Pathway and Training Pathway applicants
Electronic Funds Transfer (EFT) Authorization – form #701101
– For newly enrolling providers, disregard the mailing address on the form and submit it with the enrollment form and supporting documents.
– The form is not required if you submit a revalidation or reinstatement/reactivation and no changes to the EFT are requested.
– Form is not required if you are affiliated with a group and DO NOT have a private practice.
ETIN Certification Statement for New Enrollments – form #490602 (Not required for revalidation, reinstatement, or reactivation). If you already have an existing ETIN that you wish to affiliate with, submit the Certification Statement for Existing ETINs (EMEDNY 490601) after you receive your Provider ID. This form is available here.
Prior Conduct Questionnaire – form #431001 If you answer “Yes” to questions 1-4 in section 6 of the enrollment application, you must complete this form.
Note: If upon Department review of your application, an exclusion is found, you will be required to complete this form.
Training Pathway Only
- A Copy of the Doula Training Certificate or if the doula training organization that provided doula training does not provide a certificate of completion, a signed and dated letter on the doula training organization’s letterhead stating the doula has completed a doula training course can be substituted for a certificate.
- Additional copies of doula training to meet core and broader competencies, as applicable.
Work Experience Pathway Only
- A total of three completed Client and/or Professional Recommendation Forms – form #433403
Revalidation for Pilot Doulas Only
Provider Compliance Certification – Certification of a Provider Compliance Program may be required. By signing the CERTIFICATION STATEMENT FOR PROVIDER BILLING MEDICAID, you (or the entity) certify that, where required, you (or the entity) have adopted and implemented an effective compliance program pursuant to New York State Social Services Law section 363-d, and have satisfied the requirements of Title 18 of the New York Code, Rules and Regulations Part 521. For more information on the Provider Compliance Program, please go to the program website at https://omig.ny.gov/compliance
Maintenance Forms
If you answer ‘Yes’ to any question in Section 6 of the enrollment application, please complete the Supplemental Exclusion Form. During the Department review, if any exclusions (such as prior sanctions or compliance issues) are identified, you will be required to submit additional documentation.
Additional forms related to revalidation will be forthcoming
Mailing Instructions
- Keep a copy of all documents submitted, as requests for copies will not be honored.
- Send the completed enrollment form, required documents, and additional forms to the following:
| STANDARD MAILING | EXPEDITED / PRIORITY MAILING |
|---|---|
| eMedNY | eMedNY |
| P.O. Box 4603 | ATTN: Box 4603 |
| Rensselaer, NY 12144-4603 | 327 Columbia Turnpike Rensselaer, NY 1214 |
Step 5:
Register with the NYS Doula Community Doula Directory.
Video Guides on Medicaid for Doulas
| Doula Attestation Form |
|---|
| https://youtu.be/E67RN1QkZrI? |
| Practitioner Enrollment Form and Doula Sample |
|---|
| https://youtu.be/R226qNrEf3Q?si=RPVoz-_mc5ZfcUne |
| Navigating The eMedNY Website For Doula Providers: |
|---|
| https://youtu.be/aLojAdbQWPI |
| EFT and ETIN Forms For Doula Providers |
|---|
| https://youtu.be/enTKT8lQVAo |
| Doula Enrollment Instructions and Pathways: |
|---|
| https://youtu.be/lZdVszHIHf0 |
| Doula Directory Form: |
|---|
| https://youtu.be/NwqvZJzq2RI |
| Doula Enrollment - Client and Professional Recommendation Form: |
|---|
| https://youtu.be/Jx3Vq9wJFb4 |
| Introduction to Doula Billing: Part 1: |
|---|
| https://youtu.be/gXST1b4o4yA |
- Doula Attestation Form: https://youtu.be/E67RN1QkZrI?
- Practitioner Enrollment Form and Doula Sample: https://youtu.be/R226qNrEf3Q?
- Navigating the eMedNY Website for Doula providers: https://youtu.be/aLojAdbQWPI
- EFT and ETIN Forms for Doula providers: https://youtu.be/enTKT8lQVAo
- Doula Enrollment Instructions and Pathways: https://youtu.be/lZdVszHIHf0
- Doula Directory Form: https://youtu.be/NwqvZJzq2RI
- Doula Enrollment – Client and Professional Recommendation Form: https://youtu.be/Jx3Vq9wJFb4
- Introduction to Doula Billing: Part 1: https://youtu.be/gXST1b4o4yA