To bill NYS Medicaid for Collaborative Care (CoCM) services provided, prior approval from the Commissioner of the Department of Health and the Commissioner of the Office of Mental Health, or their designees, must be obtained.
Please provide all the information requested within this form. Organizations seeking certification for additional sites must complete a separate abbreviated application for each site. A link to the abbreviated application to add a practice to an existing system/application can be found at the end of this form.
Incomplete applications will not be processed. All Fields are required. A copy of your response will be emailed to you after you submit.
By clicking "Next," you will begin your application. You will be able to save a draft of your form and continue at any time using the toolbar at the top of each page. A unique link will be sent to your email from Alchemer (noreply@alchemer.com).