Medical Billing Services in New York
Medical billing for New York practices — NGS Medicare, eMedNY and Medicaid managed care, and a commercial market split between downstate and upstate Blue plans.
New York Billing Changes Across the State
New York practices face one of the most fragmented payer markets in the country. Downstate, Empire BCBS, EmblemHealth, Healthfirst, MetroPlus and Fidelis Care are common; upstate, Excellus BCBS and Highmark play a bigger role. Medicare Part B claims go to National Government Services (NGS), and most Medicaid members are enrolled in managed care plans.
Fee-for-service Medicaid claims are processed through eMedNY, the New York State Department of Health’s claims system, and Medicaid pharmacy benefits are handled separately through NYRx. Getting the plan, product and payer ID right on every claim is the first step to getting paid in New York.
What we handle for New York practices
- eMedNY Medicaid fee-for-service claims
- Medicaid managed care and HARP plan billing
- Medicare Part B claims with NGS (Jurisdiction K)
- NY Medicaid enrollment and managed care credentialing
- Downstate and upstate commercial plan rules
- Prompt-pay follow-up under New York insurance law
New York Payers We Work With
| Payer type | In New York | What it means for billing |
|---|---|---|
| Medicare Part B | National Government Services, Jurisdiction K | NGS LCDs and appeal process apply |
| Medicaid fee-for-service | NY Medicaid via eMedNY | ETIN, enrollment and eMedNY claim rules |
| Medicaid managed care | Mainstream managed care, HARP and other plans | Plan-specific credentialing, authorizations and claims |
| Commercial downstate | Empire BCBS, EmblemHealth, Healthfirst, MetroPlus, Fidelis | Different networks and payer IDs by product |
| Commercial upstate | Excellus BCBS, Highmark, MVP and national plans | Regional plan rules and fee schedules |
Payer programs and contractors change over time; we confirm current rules for each claim.
Our Services for New York Practices
Credentialing
NY Medicaid, managed care plans, NGS and downstate and upstate commercial payers.
Learn more →Denial Management
Denials from Medicare, NY Medicaid and commercial plans worked to resolution.
Learn more →Specialties We Bill For in New York
Medical Billing in New York: Common Questions
Do you provide medical billing services across New York State?
Yes. We support practices in New York City, Long Island, Westchester, the Hudson Valley, Albany, Rochester, Buffalo and across the state, working remotely in your systems.
What is eMedNY?
eMedNY is the New York State Medicaid claims processing system run for the Department of Health. Fee-for-service Medicaid claims are submitted and tracked through it; managed care plans process their own claims.
Who is the Medicare contractor for New York?
National Government Services (NGS) is the Medicare Administrative Contractor for Part A and Part B in New York (Jurisdiction K).
Does New York have a prompt-pay law?
Yes. New York insurance law sets deadlines for insurers to pay or deny clean claims and requires interest on late payments in many cases. We track payment timing and follow up when payers miss their deadlines.
Get Paid Faster by New York Payers
Our free audit reviews your recent New York claims, denials and A/R and shows you exactly what to fix.