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 multiple sites must complete a separate application for each site.
Please submit this form for each additional site after completing the full application.
Incomplete applications will not be processed.
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 noreply@alchemer.com; be sure to check your spam or junk folder if you do not see it within a few minutes.