EMedNY Remittance Retrieval 2026

1. Click ‘Get Form’ to open the eMedNY Remittance Retrieval in the editor.
2. Begin by entering the date at the top of the form. This is essential for record-keeping.
3. Fill in your Provider/Group Name and complete the address section, including City, State, and Zip Code.
4. Input your Provider Number and NPI in the designated fields to ensure proper identification.
5. Authorize eMedNY to release your remittance records by listing individuals within your organization. Provide their names, addresses, and phone numbers as required.
6. If you need to authorize more than two individuals, attach an additional sheet with their details.
7. Sign and date the form at the bottom. Ensure that it is signed by an authorized individual from your organization.
8. For future requests, remember that one of the listed individuals must initiate any request using the Remittance Copy Request Form on page 2.

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