Medical Billing Services in New York
New York Insurance Law Section 3224-a requires insurers to pay clean electronic claims within 30 days and paper claims within 45 days — a rule that shapes every clean-claim workflow for New York practices. Empire Blue Cross Blue Shield anchors New York's commercial payer mix, which means fee-schedule mastery and timely appeals are non-negotiable for practices operating in the state. New York Medicaid enforces a 365-day timely filing window, while commercial payers in the state run 90-180 days — deadlines that discipline every claim queue we manage. Our remote billing team builds New York-specific workflows around these rules, with payer-level edits, MCO portal automation, and appeals templates tuned to how New York plans actually adjudicate.
The New York Billing Landscape
New York has one of the most complex Medicaid systems in the country, with over 7 million enrollees in managed care plans including Healthfirst, Fidelis Care (Centene), Emblem Health, MetroPlus, Affinity Health Plan, and dozens of regional plans. The state's Essential Plan provides coverage for residents who don't qualify for Medicaid but can't afford marketplace plans, adding another layer of billing complexity. The commercial market is led by Empire BlueCross BlueShield (Anthem), UnitedHealthcare, Aetna, Cigna, and Oscar Health. New York's prompt pay law requires clean claims to be paid within 30 days for electronic and 45 days for paper submissions, with interest penalties at the greater of 12% annually or the federal funds rate plus 4%. The state's surprise billing law (enacted in 2015, before the federal NSA) established an independent dispute resolution process. New York City practices operate in one of the most competitive, high-overhead markets in the nation, with NYU Langone, Mount Sinai, NewYork-Presbyterian, and Northwell Health shaping contracting dynamics. Upstate New York is markedly different — Rochester, Buffalo, and Syracuse have regional health systems and lower reimbursement rates, while rural communities face provider shortages. New York mandates telehealth parity and has some of the most full behavioral health parity requirements in the nation.
Who We Serve in New York
Our New York client mix skews toward solo practices, group practices, multi-specialty clinics , plus behavioral health practices and telehealth providers. We work with providers in New York City, Buffalo, Rochester and across the rest of the state, all remotely.
Major Metros Served
Payer Landscape in New York
New York Medicaid Managed Care routes members through Fidelis Care, Healthfirst, MetroPlus Health Plan and 3 more plans, each with its own authorization rules and fee schedule. On the commercial side, Empire Blue Cross Blue Shield, UnitedHealthcare, Aetna drive the bulk of New York claim volume, so we maintain payer-specific denial playbooks and appeal templates for each. Claim clocks in New York run 365 days for Medicaid and 90-180 days for commercial payers — deadlines our A/R queues are built around. New York's prompt-pay statute: New York Insurance Law Section 3224-a requires insurers to pay clean electronic claims within 30 days and paper claims within 45 days. Late payments incur interest at the greater of the rate used by the IRS or 12% per annum.
Medicaid Program
New York Medicaid Managed Care
Managed Care Organizations
Key Commercial Payers
Timely Filing Deadlines
Prompt Pay Law
New York Insurance Law Section 3224-a requires insurers to pay clean electronic claims within 30 days and paper claims within 45 days. Late payments incur interest at the greater of the rate used by the IRS or 12% per annum.
New York Billing Regulations & Compliance
The New York State Department of Financial Services (DFS) sets the rules our New York billing workflows have to satisfy. Surprise billing in New York: New York's surprise bill protections (Financial Services Law 603) predate the federal No Surprises Act, protecting patients from balance billing for emergency and inadvertent out-of-network services with an independent dispute resolution process. Telehealth parity: New York requires insurers to cover telehealth services on the same basis as in-person visits. Medicaid covers telehealth including audio-only and telephonic services.
State Insurance Regulator
New York State Department of Financial Services (DFS)
Surprise Billing Protection
New York's surprise bill protections (Financial Services Law 603) predate the federal No Surprises Act, protecting patients from balance billing for emergency and inadvertent out-of-network services with an independent dispute resolution process.
Telehealth Billing Parity
New York requires insurers to cover telehealth services on the same basis as in-person visits. Medicaid covers telehealth including audio-only and telephonic services.
Common Questions
Common questions about medical billing services in New York.
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Get a Free Billing Audit arrow_forwardHow do you handle New York Medicaid Managed Care?
New York Medicaid Managed Care runs through plans like Fidelis, Healthfirst, and MetroPlus. Each has different billing rules, prior auth requirements, and appeal timelines. Our team manages the payer-specific workflows for your contracted plans.
What about billing differences between NYC and upstate practices?
NYC practices typically deal with higher Medicaid managed care volume and more complex multi-payer environments. Upstate practices often have a heavier commercial and Medicare mix. We adjust billing strategy based on your specific payer profile.
How does New York's surprise billing law affect us?
New York's out-of-network billing protections predate the federal No Surprises Act. We ensure compliant billing for both in-network and out-of-network claims, and manage IDR when needed.
What specialties do you support in New York?
We work with mental health practices, primary care groups, cardiology, orthopedics, and urgent care centers across New York. Each specialty team understands NY-specific payer rules and coding requirements.
What happens if a payer misses the New York prompt-pay deadline?
New York Insurance Law Section 3224-a requires insurers to pay clean electronic claims within 30 days and paper claims within 45 days. Late payments incur interest at the greater of the rate used by the IRS or 12% per annum. We track every clean claim against these New York-specific deadlines, flag stalled payments in our A/R reports, and escalate to the New York State Department of Financial Services (DFS) when a payer defaults. Medicaid claims run a 365-day timely-filing window, commercial claims run 90-180 days — we build follow-up cadences around both.
Services for New York practices
Specialties we bill for
Services in New York
Specialties in New York
Other Locations We Serve
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See where denials, follow-up delays, or workflow gaps may be hurting your New York practice's collections.