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70+
Specialties
Expertise
Expertise
Medical Billing Company New York
Medical Billing Services in
New York Medicaid, Medicare & Commercial Eligibility
AI Medical Coding, Charge Entry & Claim Review
Prior Authorization, Claims Tracking & Rejection Fixes
Accounts receivable management solutions & Old AR Cleanup
Medical Billing Services in
New York
New York Medicaid, Medicare & Commercial Eligibility
AI Medical Coding, Charge Entry & Claim Review
Prior Authorization, Claims Tracking & Rejection Fixes
Accounts receivable management solutions & Old AR Cleanup
Schedule A Free Consultation
Get expert advice tailored to your practice.
Our Core Strengths
1000+
Physicians
Served
Served
AAPC
Certified Billers
& Coders
& Coders
AI-Powered
Medical Billing
99%
First-Pass
Claim Rate
Claim Rate
New York Healthcare Medical Billing Expertise
Why State-Specific Medical Billing is Important for Your Practice
Unlike a single set of rules, medical billing rules vary across the 50 US states. Each state has its own reimbursement framework for different payers, deadlines, and medical-necessity documentation. Let’s take an example: a practice in California can submit a physical therapy claim with a standard progress note, while North Carolina often requires a physician-signed re-certification for the same visit.
Now, if we talk about New York medical billing regulations, they add another layer of specifications that most billing teams aren’t prepared for. Providers here are stuck balancing a mix of MCO regulations and New York Workers’ Compensation billing (WCB fee schedule & CMS-1500) forms. This makes it compulsory to outsource to New York’s state-specific billing experts.
NY InsuranceRegulations
Payer-Specific Rules
HIPAA Compliance
What Includes State-Specific Billing Services?
State-specific billing services align claims with the state’s fee schedules, filing deadlines, credentialing rules and dispute resolution pathway. These unique factors ensure accuracy by matching the payer regulations required for accurate reimbursement.
Payer & Network Variation
State-specific billing experts manage carrier rules, MCO requirements, and network participation differences that affect claim processing.
Coding & Documentation Variance
They align coding and documentation with state-specific reimbursement requirements to support accurate, compliant claims.
Regulatory & Compliance Updates
They track state billing laws and regulatory updates to reduce compliance risks and reimbursement delays.
Patient Billing & Disclosure Rules
They manage state-specific billing transparency and surprise billing requirements to keep patient communication compliant.
Our Expert Medical Billing Services in New York
Our medical billing experts in New York offer automated claim submission & follow-up. We follow the state-specific billing regulations to help your practice collect more revenue and have financial stability.
Eligibility Verification
Medical Coding
Claims Submission
Payment Reconciliation
Denial Management
A/R Recovery
Payer Operations & Compliance
Eligibility Verification & Prior Authorization
Insurance Eligibility & Benefits Verification
We verify patient insurance eligibility and benefits upfront to reduce denials and increase payment accuracy.
Authorization Requirement Check
We identify which services require prior approval under payer rules, including No-Fault authorization requirements for claims that get denied for these errors.
Approval Submission & Follow-Up
We submit authorization requests and follow up until they are approved, so treatment stays on schedule, and you are paid on time.
Medical Coding & Charge Capture
ICD-10-CM, CPT & HCPCS Coding Accuracy
Our AAPC-Certified coders assign the correct ICD-10-CM, CPT, and HCPCS codes for every service, reducing errors.
Automated Charge Scrubbing & Validation
Before submission, our AI claim-scrubbing software flags mismatched codes and missing modifiers, catching mistakes that typically slow reimbursement.
New York Compliance Checks
We review every charge against New York payer rules and fee schedules before submitting it for reimbursement.
Clean Claim Creation & Submission
Claim Formatting & Payer-Specific Edits
We format cleared claims into the standard 837 file, applying each payer’s specific field rules so nothing bounces back.
Modifier & Bundling Edits
Our AI engines check every claim for correct modifier use and proper code bundling, including the NCCI edit errors that most clearinghouses miss.
Confirm Submission & Tracking
Once cleared, claims route through the clearinghouse and generate an acceptance or rejection report confirming the payer received them intact.
Payment Posting & Reconciliation
ERA/EOB Payment Posting
We post 835 files for each processed claim, record exactly what was paid, and correctly identify recoupments and reversals.
Contractual Payment Review
We then check the posted payment against the contracted rate, fee schedules, and modifiers to identify underpaid or unpaid claims.
Underpayment Recovery
When we confirm a variance, we pursue the shortfall directly by filing a corrected claim or formal appeal until it’s paid.
Denial Prevention & Appeals
CARC & RARC Analysis
We trace every denied claim to its CARC and RARC codes to identify the reason for repeated payer rejections.
Resubmission or Formal Appeal
Based on the denial reason, we either correct and resubmit the claim or escalate it to a formal written appeal.
Appeal Follow-up & Resolution
Appeals are tracked against payer deadlines, with arbitration support available for disputes that don’t resolve through standard appeal.
A/R Recovery & Payer Follow-up
A/R Analysis & Prioritization
We sort unpaid claims by payer type, receivable amount, and denial risk so the oldest and highest-value accounts get worked first.
Payer Follow-Up & Escalation
We track unresolved claims by escalation date and reconsideration status, then follow up directly with payers.
Old Account Receivable Recovery
We recover aged claims over 90 days by re-verifying eligibility, correcting errors and resubmitting or appealing before the timely filing limits expire.
New York Payer Operations & Compliance
Enrollment & Payer Setup
We manage provider enrollment, PMS setup, provider service location and other delegated network requirements.
New York Rule Alignment
We align every claim submission workflow with NY Medicaid plans, Regulation 68, the WCB fee schedule, and Prompt Pay Law timelines.
Medical Billing Expert Witness New York
When billing disputes go to court, our experts analyze your claims and testify to back up your case.
Your practice needs steady cash flow.
Let our expert medical billing NYC team design HIPAA-compliant billing workflows to improve reimbursement rates.
99% First
Pass Rate
Fixed Claim
Denials
Accurate
Reimbursements
Our Client Success Stories
Our Medi-Cal denials finally stopped after MedsIT fixed IPA routing and matched every authorization correctly before submission.
They found our failed Medicare crossovers, corrected our COB data, and recovered balances we had nearly written off.
Their team corrected our telehealth modifiers and POS coding, and the repeat California payer denials disappeared completely.
Our workers’ compensation claims moved again once they aligned injury reports, authorizations, and required California billing forms.
They compared our ERAs against contracted rates, appealed every variance, and recovered payments we were still missing.
They uncovered mismatched taxonomy and rendering-provider data, corrected 837 files, and finally resolved denials we couldn’t explain.
New York Practices We Serve
Hospitals & Health Systems
We handle facility & physician billing, denial follow-ups, DRG review, and underpayment recovery & revenue leakage prevention across complex hospitals.
Independent & Multi-Specialty Practices
From family practice billing services to internal medicine billing services, we organize workflows by provider and payer for accurate revenue tracking.
Ambulatory Surgery Centers
We coordinate implants, global periods, prior authorizations and facility claims before anything reaches New York payers.
Behavioral Health & SUD Facilities
We manage ongoing authorizations, visit-limit tracking, telehealth billing, and medical-necessity documentation according to payer-specific requirements.
FQHCs, RHCs & Community Clinics
We process wrap-around payments and patient visit billing, and NY Medicaid and Medicare reconciliation built for safety-net provider requirements
Specialty Physician Groups
Our physician medical billing services cover complex coding, medical-necessity review, and specialty-specific payer edits, when required.
Our Process
01. Claim Review
We have AI scanners to review superbills and EHR reports and detect missing fields and NY payer gaps before coding them.
02. Codes Scrubbing
Our automated scrubbers check these claims for ICD-10-CM, CPT & HCPCS coding accuracy against the NY Medicaid rules to catch modifier and NCCI edits.
03. Claim Submission
After fixing the format, specialty codes, and place-of-service codes for New York payers, we route them for reimbursement.
04. Denial Tracking
Our healthcare denial management services tag the main reason for denial. Then we cross-check it against the NY payer regulations and the required medical-necessity documentation.
05. Payment Posting
We match the received payments against the contracted rates to flag any underpaid claims. Our automated dashboards generate monthly revenue reports to track them.
What Makes Us the Leading Medical Billing Company in New York?
Our medical billing experts New York offer advanced reimbursement solutions. We pair dedicated account managers with AI-powered analytics that flag revenue risks. From Article 28 facilities to NYC groups and independent practices, we’ve got you covered. With seamless EHR integration and dashboards, we deliver accuracy and clarity in your revenue.
100% HIPAA-compliant billing workflows & payment posting.
99% first-pass rate with accurate & faster reimbursements.
Reduced accounts receivable days to 22 with AI follow-up cycles.
AI-assisted accounts receivable management solutions & old AR cleanup.
Claims are designed in New York Prompt Pay Law compliance.
42% reduction in claim denials with payer-specific coding.
Why Choose MedsIT Nexus Among Other New York Medical Billing Companies
New York Medical Billing Laws Expertise
Expertise Across 70+ Medical Specialties
State-Compliant Coding Services
All New York Payer Expertise
New York Medical Billing Laws Expertise
NY Surprise Bill Law & No Surprises Act Compliance
We navigate state-level IDR arbitration workflows and track mandatory pre-review fees to avoid out-of-network balance-billing disputes.
eMedNY & Medicaid Claim Compliance
We manage eMedNY eligibility, correct NPI usage, and New York Medicaid billing requirements to reduce claim errors and reimbursement delays.
Data Security & The SHIELD Act
Our billing goes beyond HIPAA with encrypted PHI transmission and documented breach protocols to maintain full SHIELD compliance.
Prompt Pay Law - Section 3224-a
Our aging workflows track New York’s 30/45-day prompt-pay thresholds, flag overdue qualifying claims, and follow up on statutory interest owed for late payer reimbursement.
New York False Claims Act
We have AI coding scrubbers to eliminate overcharging and unbundling risks, preserving flawless, defensible digital audit trails for your protection.
Price Transparency Obligations
We integrate hospital financial assistance tiers into patient statements, delivering plain-language billing and instant itemized cost breakdowns.
Certified New York Medical Coding Services
Our team of AAPC- and CPC-certified coders reviews the clinical documentation and connects it with ICD-10-CM, CPT & HCPCS coding accuracy aligned with New York payer requirements.
ICD-10-CM Diagnosis Coding Precision
We assign diagnosis codes that precisely justify medical necessity and disease severity, closing coding gaps that cause claim denials.
HCPCS Level II Coding
We code supplies, DME, and injectable drugs separately under HCPCS Level II to ensure these commonly overlooked charge lines are captured and paid.
Specialty-Specific Coding Certification
Our AAPC-certified coders apply specialty-specific logic across all specialties, including cardiology, orthopedics, and more, where generic coding can lead to claim rejection.
CPT Procedure Coding
We use accurate procedure codes for surgeries and office visits to match documentation exactly, so reimbursement reflects the actual care delivered.
NCCI Edit And Modifier Application
Our team checks every code combination against NCCI bundling edits and applies modifiers correctly to prevent unbundling denials.
HCC Risk Adjustment Coding
For Medicaid Managed Care contracts, we ensure HCC codes are captured accurately so that reimbursement based on them remains protected.
Revenue Cycle Management Services for
70+ Medical Specialties
Cardiology
Family Medicine
Primary Care
OB/GYN
Behavioral Health
Orthopedics
General Surgery
Dermatology
Gastroenterology
Mental Health
Pain Management
Occupational Billing
New York Payer Expertise
Our NY payer expertise keeps your claims aligned with payer-specific regulations and requirements, increasing collection rates and reducing denials.
UnitedHealthcare
We present UnitedHealthcare’s high denial volume across commercial, Medicare Advantage, and Medicaid lines and route every claim to the correct plan type.
Cigna
Where Cigna’s prior authorization management rules shift frequently, our team tracks every update in real time to prevent approvals from being denied mid-treatment.
Aetna
Aetna’s complex documentation standards require more than routine notes, so we align clinical records with medical-necessity criteria before submission.
No-Fault Auto Insurance Carriers
New York No-Fault auto insurance billing is governed by Regulation 68’s verification deadlines, and we meet every deadline before arbitration becomes necessary.
Managed Long-Term Care (MLTC) Plans
We manage MLTC eligibility, authorization, plan-specific billing rules, and claim follow-up to reduce denials and protect reimbursement.
Dr. Marcus Feldman, DC
Clinical Director,
Empire State Chiropractic & Rehab, Queens, NY
“Our No-Fault claims kept getting denied over verification requests we didn’t even know had deadlines. MedsIT Nexus rebuilt our whole VR response process, we stopped losing revenue to a clock we weren’t watching.”
First-pass payment rate improved from 78.4% to 91.6%.
Average payment delay decreased from 38 days to 24 days.
Case Study #1
Read Full Case Study
Regulation 68 Verification Request Failures Resolved by 38.6% Reduction in No-Fault Denials
Empire State Chiropractic & Rehab was filing NF-3 claims correctly. But 41% of claims were still denied under Regulation 68. The problem was verification requests (VRs) from No-Fault carriers. Their front-desk staff tracked VR deadlines manually in a shared spreadsheet. They often missed deadlines or answered requests with incomplete documents.
MedsIT Nexus set up an automated VR tracking system. It’s tied to each claim’s submission date and checks carrier-specific deadlines under 11 NYCRR 65. Every VR now gets flagged, assigned, and documented before its deadline. We attach clinical records with the first response, so carriers don’t come back asking for more.
Outcomes
- 38.6% reduction in Regulation 68-related denials
- $267K in previously written-off No-Fault claims recovered through timely re-filing
- 51 → 12 days average VR response turnaround time
EHR, PMS
& Billing Integrations
Seamless Integrations. Smarter Revenue
We connect with leading EHR, Practice Management, and Billing platforms to keep your data accurate, claims clean, and revenue moving.
Best Medical Billing Services New York Cities & Counties
Rochester
Syracuse
Yonkers
New York County
Queens County
Bronx County
Richmond County
Kings County
New York Compliant Credentialing Services
We understand that medical billing & credentialing services require accurate licensing, timely completion, payer-specific requirements, and continuous tracking. We treat each provider’s enrollment as a priority, not a routine paperwork task.
License & Profile Integrity Check
- We confirm every provider holds an active New York license and current DEA registration.
- We review and attest each CAQH profile, fixing gaps that would otherwise delay enrollment.
- We check Type 1 and Type 2 NPI records against NPPES to resolve mismatches.
Enrollment Pathway Mapping
- We map each payer’s exact enrollment route for all eMedNY and commercial networks.
- We route applications correctly, avoiding duplicate direct payer submissions.
- We sequence applications strategically, since some payers require Medicaid or Medicare enrollment first.
Application Build & Submission
- We gather licenses, certifications, and malpractice history to verify accuracy.
- Each application follows the payer’s exact format to avoid rejections.
- Our AI systems submit & track confirmation receipts to confirm reimbursement.
Effective Date Control
- We finalize enrollment before the patient visit to avoid missing documents.
- We set the provider’s clinical start date once we confirm the payer’s date.
- We follow up directly with payers to lock in exact dates in records.
Recredentialing & Maintenance
- We track New York’s triennial license registration with every payer’s revalidation cycle
- We track license and DEA renewal dates to prevent automatic de-credentialing.
- We re-attest CAQH profiles on schedule to keep every linked payer’s records up to date.
Get Credentialed Today.
Our credentialing services help you skip months of paperwork with accurate applications and faster enrollment. Let’s get you registered and ready to bill.
No Enrollment
Gaps
Cleaner Payer
Files
Less
Paperwork
Talk to Our Credentialing Expert
No confusion. Just clear credentialing support.
Our Onboarding Process
We follow an organized onboarding process to keep your billing stable. Our process includes payer setup, HIPAA-compliant billing workflows & payment posting with performance tracking.
Step 1
Billing & Revenue Assessment
We review your current billing workflows, payer mix, aged A/R, denial history, specialties, and service locations to identify existing revenue risks.
Step 2
Secure Documentation Intake
We collect provider records, payer contracts, fee schedules, system credentials, claim files, and enrollment details through encrypted channels.
Step 3
Payer & Workflow Configuration
We map Medicaid, Medicare, No-Fault, Workers’ Comp, and commercial payer rules directly into your practice’s billing workflow.
Step 4
EHR & Clearinghouse Integration
We configure and fully test your EHR, practice management system, clearinghouse, ERA, EFT, and claim-routing connections.
Step 5
Claims Testing & Validation
Then we test the claims through coding, eligibility, authorization, payer edits, payment posting, and reporting checks to confirm accuracy.
Step 6
Go-Live & Performance Monitoring
After that our billing goes fully live with AI claim trackers for denial monitoring, A/R oversight, and scheduled performance reporting from week one.
Get Medical Billing Services in New York
Share your practice details and select your billing challenges below. Our experts will review your information and provide personalized recommendations to improve your revenue cycle.
Frequently Asked Questions
Trusted in 50 States by 500+ Providers
New York Medicaid billing mainly runs through eMedNY for fee-for-service claims, but most patients fall under Medicaid Managed Care. As a result, providers must enroll separately with plans like Healthfirst or Fidelis, each with its own submission and authorization rules.
MedsIT Nexus offers advanced reimbursement solutions across 70+ specialties. Our medical billing NYC expertise delivers a 90% collection ratio and a 99% first-pass claim rate. Our services are compliant with New York’s No-Fault, Medicaid Managed Care, and Prompt Pay rules. We turn billing complexity into faster, more accurate reimbursements for your practice.
Mainly, New York practices face denied and delayed claims because they don’t fully understand NY payer complexities. We have expertise in Regulation 68 No-Fault timelines, Medicaid Managed Care rules, and commercial documentation standards. Our company offers AI-driven claim scrubbing to achieve a 99% first-pass rate and 90% collection ratio for your practice.
MedsIT Nexus integrates advanced technology into the billing process to keep it fast and error-free. We overcome NY billing challenges with a team of certified medical billers and coders who know New York medical billing laws. We guarantee payer compliance with a 35% increase in your revenue.
Credentialing timelines with New York payers vary; for example, Medicare takes 60 to 90 days, Medicaid takes around 45 to 90 days, and other commercial payers take 90 to 150 days. It depends on the payer network complexity. We track every application so we can start billing as soon as enrollment is complete.
There are two types of credentialing. In direct credentialing, a provider applies straight to each payer. Delegated credentialing means a hospital or IPA verifies credentials for the payer. Knowing about these helps you navigate your application efficiently.
Out-of-state doctors need a New York State medical license, updated CAQH and NPI records, DEA re-registration, and separate payer enrollment with Medicaid, Medicare, and commercial plans.
Credentialing applications are delayed when CAQH profiles are outdated, payer-specific forms are filled out generically, and effective dates are not confirmed in the documents. These gaps turn routine enrollment into months of working with payers.
After a car accident, providers submit an NF-3 form with treatment details. The insurer can request more documents through a verification request, which has strict response deadlines. Once verified, insurers must pay or deny claims within 30 days under Regulation 68.
Workers’ comp claims in New York are billed on standard CMS-1500 forms under the WCB fee schedule. Providers submit medical reports for authorization, and the employer’s carrier or the state’s workers’ comp insurer processes payment.
Payer deadlines vary across New York. For example, New York Medicaid allows 90 days, Healthfirst allows 180 days, Empire’s commercial plans allow 120 days, and UnitedHealthcare and Cigna typically require 90 days in-network. Missing any of these windows means lost revenue.
New York’s Prompt Pay Law requires insurers to process clean claims within set deadlines. If a payer misses that window, your practice may be entitled to interest on the delayed payment, which increases the reimbursement rate.
When choosing an accounts receivable partner, look for New York-specific payer experience, proven denial-recovery numbers, transparent reporting, and clear communication. Prioritize partners who understand Regulation 68, Medicaid Managed Care regulations, and your specialty’s unique billing challenges.
Don’t do the complete transfer in one go; start small. Automate time tracking first, then invoicing, then payment reminders. Integrate your practice management software with an AR platform, migrate client data in phases, and run both systems in parallel for one billing cycle before fully switching to automated collections.
In-house teams confuse patient care and paperwork, letting aged claims slip past filing deadlines. A dedicated New York A/R service tracks every unpaid claim daily, follows state-specific payer rules and recovers revenue your staff doesn’t have time to chase.
New York’s Prompt Pay Law requires payers to process clean claims within set deadlines, reducing the days in A/R. Practices that track these deadlines closely recover payment faster, while missed enforcement lets aging claims slip through. It loses your practice’s revenue that should be collected.