Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with New York Medicaid Choice before sending sensitive documents. FaxFlow is not affiliated with this organization.
New York Medicaid Choice fax number
(800) 505-5678
New York State Department of Health – Medicaid Managed Care (New York Medicaid Choice), administered by Maximus
Used for: Enrollment in Medicaid Managed Care; submission of enrollment/designation forms to New York Medicaid Choice
Fax destination details
- Department
- New York State Department of Health – Medicaid Managed Care (New York Medicaid Choice), administered by Maximus
- Purpose
- Enrollment in Medicaid Managed Care; submission of enrollment/designation forms to New York Medicaid Choice
- Form
- MM-CF-0822 — Authorized Representative Designation Form
- Address
- New York Medicaid Choice, PO Box 5009, New York, NY 10274
- Voice phone
- 1-800-505-5678
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Complete and sign this form to designate an authorized representative for New York Medicaid Choice. You can fax the completed form to (917) 228-8601 or mail it to New York Medicaid Choice, PO Box 5009, New York, NY 10274.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
FaxFlow records the public sources found during directory research. A source link is useful evidence, but it is not a guarantee that a number still reaches the same team.
No public source link was saved with this record. Confirm the number directly with the organization before using it.