New York Medicaid Electronic Health Records (EHR) Incentive Program

Eligible Professionals (EPs)

Important: All NY Medicaid EHR Incentive Program forms are offered on the NY Medicaid EHR Incentive Program website in their required file format for submission. If you are having difficulty using one of the forms or need to request it in a different more accessible file format, please contact the NY Medicaid EHR Incentive Program at (877)-646-5410, Option 2 or hit@health.ny.gov.

  • Appeal Request Form (XLSM)
  • Attestation Deadline Extension (ADE) Form (XLS)
  • Greenway EHR Identification Form (XLSX)
  • Group EPs Pre-Validation (XLSX)
  • Individual EPs Pre-Validation (XLSX)
  • Numerator Request Form (XLSX)
  • NY Medicaid EHR Incentive Program MPV Workbook (XLS)