State · NY
Medical billing services in New York
Short answer
Medical billing services in New York have to work inside a Medicaid program that gives you 90 days from the date of service to file with eMedNY, a prompt pay law that sets 30 days for electronic clean claims and 45 for paper, more than a dozen mainstream managed care plans certified by the Department of Health, one statewide transportation broker, and telehealth payment parity written into both the Insurance Law and the Public Health Law.
Remitwright assigns a dedicated biller to each client, serving New York practices remotely, who works eMedNY, the plan portals and the commercial payers from one claim queue. Rules for other states are on the medical billing services by state page.
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Billing in New York: what's different
The rules below change how a claim is filed and paid in New York. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.
| Fact | In New York | Source |
|---|---|---|
| Medicaid program | New York State MedicaidNew York State Department of Health, with eMedNY as the Medicaid claims and information system | 3 |
| Fee-for-service portal | EPACES (electronic Provider Assisted Claim Entry System) on eMedNY | 3 |
| Managed care plans | 14 plansAmida Care, Capital District Physicians' Health Plan (CDPHP), Excellus Health Plan, Health Insurance Plan of Greater New York (HIP), Healthfirst PHSP, Highmark Western and Northeastern New York, Anthem HP, Independent Health Association, MetroPlus Health Plan, Molina Healthcare of New York, MVP Health Plan, New York Quality Healthcare Corporation, United Healthcare of New York, VNS Choice SNP | 5 |
| Medicaid timely filing (fee-for-service) | 90 days from the date of service | 6 |
| Prompt-pay law | New York Insurance Law section 3224-a | 8 |
| EVV | EVV Choice Model | 12 |
New York State Medicaid
New York State Medicaid is run by the New York State Department of Health, with eMedNY as the Medicaid claims and information system. Fee-for-service claims and provider enrollment go through ePACES (electronic Provider Assisted Claim Entry System) on eMedNY3, at epaces.emedny.org. Mainstream Medicaid Managed Care, with HARP and Managed Long-Term Care as separate managed care programs, run by the Department of Health through plans it certifies4. Enrollees pick a plan and a primary care practitioner who coordinates their care. The Department of Health publishes the directory of certified plans and a county-by-county list of what is offered where.
Fee-for-service filing limit: 90 days from the date of service for the initial claim to eMedNY, with a final cutoff of two years6. A claim returned for correction must be resubmitted within 60 days of the notice. A claim delayed by circumstances outside your control goes in within 30 days of the delay clearing, with a delay reason code. Managed care plans set their own limits in their provider contracts.
Managed care plans5
- Amida CareSpecial Needs Plan
- Capital District Physicians' Health Plan (CDPHP)
- Excellus Health Plan
- Health Insurance Plan of Greater New York (HIP)Reported in DOH enrollment data as HIP of Greater New York, the EmblemHealth HMO
- Healthfirst PHSP
- Highmark Western and Northeastern New York
- Anthem HPReported in DOH enrollment data as Anthem Blue Cross and Blue Shield
- Independent Health Association
- MetroPlus Health PlanAlso operates a Special Needs Plan
- Molina Healthcare of New York
- MVP Health Plan
- New York Quality Healthcare CorporationReported in DOH enrollment data as Fidelis Care
- United Healthcare of New York
- VNS Choice SNPSpecial Needs Plan
Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins New York Medicaid through one plan is not in network with the others until each contract is in place.
Commercial payers and the prompt-pay law
Commercial payers active in New York9: UnitedHealthcare and Oxford Health Insurance, Aetna Life Insurance Company, Anthem HealthChoice, EmblemHealth, Excellus Health Plan, Highmark Western and Northeastern New York, MVP Health Plan, CDPHP. Each has its own filing window, corrected-claim process and appeal levels in its provider manual, and the timely filing limits table lists verified payer deadlines with their sources.
Clean-claim payment window under New York Insurance Law section 3224-a: 30 days for claims transmitted electronically, 45 days for paper or fax8. The payer has 30 calendar days from receipt to pay, deny, or ask for the specific information it still needs. Late payment carries interest at the greater of the state corporate tax rate or 12 percent a year. For a New York practice, the statute does its work in A/R follow-up: a clean claim still unpaid after the window is escalated with the statute cited, and interest is requested where the law provides it.
NEMT and home care in New York
Non-emergency medical transportation. One statewide transportation broker, Medical Answering Services (MAS), schedules trips, runs the call centers and performs utilization review for Medicaid transportation10. MAS runs a downstate region for New York City, Nassau, Suffolk, Westchester and Putnam and an upstate region for the rest of the state. Members or their offices request rides at least 72 hours before the appointment. The NEMT billing in New York page covers trip documentation, broker claims and reconciliation.
Electronic visit verification. EVV Choice Model: you pick any EVV system you like, and the visit data goes to the state aggregator in eMedNY through the eMedNY web portal or API gateway12. Applies to Medicaid personal care services and home health services that require an in-home visit. Providers enroll in eMedNY, sign up on the web portal, then connect through the API gateway, and attest to compliance. See home care billing in New York for waiver programs, EVV exceptions and authorizations.
Rules that change how New York claims are billed
Surprise bill protections and independent dispute resolution13
A patient pays only in-network cost sharing for emergency services, and for out-of-network care at an in-network hospital or ambulatory surgery center when no in-network provider was available or the patient was not told. Providers may bill only that cost sharing. Payment disputes go to an independent dispute resolution entity, which rules within 45 business days of receiving everything it needs.
Telehealth payment parity for commercial plans14
Insurance Law 3217-h bars an insurer from excluding a covered service because it was delivered by telehealth and requires reimbursement on the same basis, at the same rate and to the same extent as in-person care. Cost sharing and utilization management may apply, but on terms no less favorable than in-person care.
Telehealth payment parity for Medicaid15
Public Health Law 2999-dd entitles telehealth services to Medicaid reimbursement on the same basis, at the same rate and to the same extent as the equivalent in-person service. That wording is in force until April 1, 2028, after which the section changes and reimbursement depends on federal financial participation.
Revalidation of every Medicaid provider by June 202816
New York is revalidating all providers by June 2028 under federal requirements. Revalidations are filed in the Provider Services Portal and should not be attempted until the enrollment contractor emails you to start.
Transportation is carved out of mainstream managed care11
Mainstream managed care enrollees moved to the Department's contracted transportation broker on December 1, 2015, so non-emergency transportation is authorized through MAS and billed outside the health plan. Prior authorization has to be in place before the transportation expense is incurred, and vendors attest, cancel or change trips in the MAS system.
Claims over 90 days need a delay reason7
A claim first filed more than 90 days after the date of service is only valid if the delay was outside your control, and it has to be filed within 30 days of the time submission came within your control, with the delay reason coded on the claim. Claims over two years old follow a separate eMedNY procedure.
Services for New York practices
Remitwright serves New York practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.
- Medical billingClaims worked by one named biller
- CredentialingEnrollment, CAQH and PECOS kept current
- Eligibility verificationCoverage and benefits checked before visits
- Prior authorizationAuths requested, tracked, attached to claims
- Denial managementEvery denial read, worked and appealed
- A/R follow-upUnpaid claims chased before filing limits
FAQ
Questions from New York practices
How long do we have to file a New York Medicaid claim?
What is the prompt pay rule for commercial claims in New York?
Do we bill eMedNY or the managed care plan?
How does Medicaid transportation work for our patients?
Which EVV system do we need for home care in New York?
Does New York pay the same for telehealth as for an office visit?
When do we have to revalidate our Medicaid enrollment?
Where did the list of commercial payers on this page come from?
Which managed care plans run Medicaid in New York?
Who runs Medicaid in New York, and where do fee-for-service claims go?
Next step
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