New York carries two payer types most states handle as an afterthought: no-fault motor vehicle coverage and workers' compensation, both with their own forms, fee schedules and deadlines. A practice seeing either and billing it like commercial insurance loses the money on process, not on merit. Add a Medicaid program with a 90-day filing rule and a managed care market that looks completely different in Buffalo than in Brooklyn, and medical billing services in New York have to be built around deadlines first.
No-fault and workers' compensation are their own category
Both run on the workers' compensation fee schedule and their own paperwork, and both have filing deadlines shorter and less forgiving than commercial timelines. Verification requests and independent medical examinations are part of the process rather than exceptions. These claims are worked as their own category with their own follow-up clock, because folding them into a commercial A/R queue is how they age past the point of recovery, and New York carriers know it.
eMedNY enrollment, ETIN setup and licensing
Enrollment in New York Medicaid goes through eMedNY with a packet specific to the provider type, and approval alone does not let you bill. Submitting electronically takes an Electronic Transmitter Identification Number, the ETIN, backed by a certification statement that has to be recertified every year or eligibility checks, claim submission and remittance access stop together. ePACES, the free web submission tool, hangs off the same ETIN. Because of the 21st Century Cures Act, every provider in a Medicaid managed care network also has to be enrolled with the state, and plans are required to drop providers who are not, so the eMedNY record protects the managed care revenue too. Fee-for-service claims must be submitted within 90 days of the service, later submissions need a valid delay reason code, and nothing is payable past two years. Medicare Part B in New York is administered by National Government Services as the Jurisdiction K contractor through PECOS. Commercial plans credential from CAQH ProView. Physicians renew their New York registration with the State Education Department every two years, and treating workers' compensation patients requires separate Board authorization plus a Medical Portal account for OnBoard. We hold all of it on one calendar per provider.
Downstate and upstate are different markets
The plan mix a practice in New York City deals with is not the plan mix in Buffalo, Rochester or Albany. Downstate Medicaid runs heavily through Fidelis Care, Healthfirst and MetroPlus, commercial business through Anthem, EmblemHealth, Oxford and Aetna. Upstate, Excellus and MVP carry much of the commercial and exchange membership and the Medicaid plan list per county is shorter. We confirm the actual payer set for the practice and each provider's participation with it rather than applying a statewide template.
No-fault billing mechanics: NF-3, verification and arbitration
Bills go to the no-fault carrier on the NF-3 verification of treatment form, priced off the workers' compensation fee schedule that Regulation 83 adopts, and Regulation 68 requires them within 45 days of the service unless the practice can show a reasonable excuse. A carrier that wants records or an examination sends a verification request, and its payment clock does not run until the practice answers it, so an unanswered request is not a pending claim but a stalled one. A denial arrives on an NF-10 and, if it is wrong, the remedy is arbitration through the American Arbitration Association or suit, not a payer appeal letter. We track every request, response and deadline as its own dated item.
Workers' compensation: CMS-1500, OnBoard and the Board's guidelines
The Workers' Compensation Board replaced its own billing forms with the CMS-1500 in 2022 and since August 2025 requires providers to submit it electronically through a Board-approved submission partner, with a narrative report attached or the bill is not considered received. Treatment outside the Medical Treatment Guidelines needs a prior authorization request filed in OnBoard, the Board's web platform, and an unpaid or short-paid bill is escalated with a Request for Decision on Unpaid Medical Bills rather than a phone call. We run the comp queue inside those rules, because the Board's process is the only real pressure a practice can put on a slow carrier.
Medical billing for New York City multi-site and hospital-affiliated groups
A group spread across the boroughs, Long Island and Westchester usually carries more than one tax ID, often with one hospital-affiliated site on a different contract set. Managed care participation is confirmed per site and per provider, because a plan that knows the Manhattan office may have no record of the Queens one. New York's prompt-pay law, Insurance Law 3224-a, requires insurers and HMOs to pay undisputed claims within 30 days electronically or 45 on paper and to add interest when they run over, and the state's surprise-bill law routes out-of-network disputes on state-regulated plans through the Department of Financial Services' independent dispute resolution process. We follow up against those obligations, separate collections and denials per location, and reconcile payments against each contract, so a site that is quietly underpaid does not average out against the group. The free billing audit is the fastest way to see whether that is happening to you.
New York State Medicaid
Fee-for-service claims run through eMedNY under a 90-day filing rule, while most members are in a managed care plan with its own submission rules. Since the 21st Century Cures Act, every plan network provider also has to hold an active New York Medicaid enrollment or the plan is required to remove them, so the state record and the plan contract have to be kept current together.
- Program
- New York State Medicaid
- Administered by
- New York State Department of Health, with eMedNY as fiscal agent for provider enrollment, claims and remittances
- Managed care
- New York Medicaid Managed Care, with plans such as Fidelis Care, Healthfirst, MetroPlus, Molina and UnitedHealthcare Community Plan participating county by county
Payers We Work With in New York
- Fidelis Care
- Healthfirst
- EmblemHealth
- Anthem Blue Cross Blue Shield (formerly Empire)
- UnitedHealthcare and Oxford
- Excellus BlueCross BlueShield
- MVP Health Care
- New York State Medicaid through eMedNY
Not an exhaustive list, and not a claim of network participation on your behalf. It is the payer mix we are set up to work in New York.
Services Available to New York Practices
Billing in New York: Common Questions
Yes, as separate categories with their own forms, fee schedules and deadlines. No-fault bills go out on the NF-3 inside the 45-day window and comp bills go out on the CMS-1500 through a Board-approved electronic partner, and neither sits in the commercial follow-up queue.
Yes, both fee-for-service through eMedNY and the Medicaid managed care plans, enrolled and billed separately. We keep the ETIN certification current, track revalidation dates per provider and use delay reason codes correctly when a claim has a legitimate reason to be past 90 days.
The enrollment packet is specific to provider type and goes to eMedNY with the license, NPI and disclosure forms. A complete application is generally processed in a matter of weeks, and the ETIN and ePACES setup that let you actually submit claims are separate steps we complete alongside it, so you are not approved but unable to bill.
Yes. Behavioral health has its own authorization and documentation expectations under the managed care plans, and its denials do not look like a surgical practice’s. It is billed with those rules rather than generic ones, and the plan participation is confirmed per provider.
Each no-fault bill has its own 45-day submission deadline, and each verification request pauses the carrier’s payment clock until it is answered. Both are logged as dated items and worked from a separate queue, so nothing waits behind commercial follow-up while the window closes.
The free billing audit first, then a signed agreement and BAA. We run in parallel with your current process for two to four weeks inside your existing system, confirming eMedNY enrollment, managed care participation and the no-fault and workers’ compensation setup before taking the full cycle.