Medical Billing Services in New York
Billing, coding, credentialing and denial management for New York practices, with Medicare claims through National Government Services (Jurisdiction JK) and New York Medicaid handled by people who know the rules.
Medical billing for New York practices
New York has one of the largest Medicaid programs in the country, and most members are in managed care. Fidelis Care and Healthfirst alone cover well over two million Medicaid members, followed by MetroPlusHealth, Anthem, UnitedHealthcare and Molina. Practices in New York City also deal with heavy commercial volume from Anthem, EmblemHealth, Aetna and UnitedHealthcare, while upstate offices see more Excellus, MVP and CDPHP.
Medicare Part B claims go to National Government Services in Jurisdiction K. NYS Medicaid fee-for-service claims through eMedNY carry a 90-day submission rule, and each managed care plan has its own authorization list. SFA Solutions works with practices across New York remotely from Austin, inside your current EHR, and reviews claims against applicable payer rules before they go out.
New York at a glance
| Medicare contractor | National Government Services, Jurisdiction JK |
|---|---|
| Medicaid timely filing | 90 days from the date of service for fee-for-service claims (18 NYCRR 540.6), with a final limit of 2 years when an accepted delay reason applies; managed care plans set their own limits by contract |
| NP practice authority | Full |
| Cities we serve | New York City, Buffalo, Rochester, Yonkers, Syracuse, Albany, Long Island, White Plains, Utica, Binghamton |
What New York billing involves
These are the programs and rules our team works with for New York claims.
Medicare
National Government Services · JKNew York Part B claims are processed by National Government Services in Jurisdiction JK. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
New York Medicaid
New York State Medicaid, administered by the NYS Department of Health; Child Health Plus covers children above Medicaid income limits
Portal: eMedNY for fee-for-service enrollment, eligibility (ePACES) and claims, operated by the state's Medicaid fiscal agent for the Department of Health
Medicaid managed care
Most members are enrolled in mainstream Medicaid managed care. The largest plans by enrollment are Fidelis Care, Healthfirst, MetroPlusHealth, Anthem Blue Cross and Blue Shield, UnitedHealthcare and Molina Healthcare of New York.
Timely filing
90 days from the date of service for fee-for-service claims (18 NYCRR 540.6), with a final limit of 2 years when an accepted delay reason applies; managed care plans set their own limits by contract.
Commercial and Medicare Advantage
Anthem Blue Cross and Blue Shield (formerly Empire), EmblemHealth, UnitedHealthcare, Aetna and Cigna are major carriers downstate. Upstate, Excellus BlueCross BlueShield, Highmark Blue Cross Blue Shield of Western New York, MVP Health Care, CDPHP and Independent Health are major carriers.
Prompt pay law
New York Insurance Law Section 3224-a requires insurers to pay undisputed claims within 30 days when submitted electronically and 45 days when submitted on paper or fax.
Nurse practitioners
Full practiceNPs with more than 3,600 hours of practice can practice without a written collaborative agreement; newer NPs still need a written practice agreement and protocols with a collaborating physician. Education Law 6902, as revised in May 2026, keeps this rule in place until July 1, 2030.
Credentialing
Enroll in NYS Medicaid through eMedNY, including ordering and referring providers, before joining any managed care plan. Most New York plans credential through CAQH ProView, and several large plans use delegated credentialing with health systems. Medicaid enrollment must be revalidated at least every five years.
Billing challenges New York practices face
The 90-day Medicaid rule
eMedNY rejects fee-for-service claims submitted more than 90 days after the date of service unless a valid delay reason code applies. Delay reasons need supporting documentation, so the safest approach is billing within days of the visit.
Medicaid managed care volume
With Fidelis Care, Healthfirst, MetroPlusHealth and other plans covering most Medicaid members, practices need to verify the plan on every visit and follow each plan's authorization and referral rules. Wrong-plan claims are a top denial reason downstate.
Surprise bill and IDR rules
New York has its own surprise bill and independent dispute resolution law alongside the federal No Surprises Act. Out-of-network practices need to know which process applies to each claim before they bill the patient.
Our services in New York
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in New York
New York medical billing questions
What is the timely filing limit for New York Medicaid?
Fee-for-service claims must be submitted to eMedNY within 90 days of the date of service unless an accepted delay reason applies. Medicaid managed care plans set their own limits in the provider contract. We submit most clean claims within 24 hours, which keeps them well ahead of that limit.
How fast do New York insurers have to pay?
Insurance Law Section 3224-a requires payment of undisputed claims within 30 days for electronic submissions and 45 days for paper. Late payments are subject to interest under the same statute.
Who is the Medicare contractor for New York?
National Government Services (NGS) is the Part A and Part B contractor for New York under Jurisdiction K. Provider enrollment changes go through PECOS.
Can New York nurse practitioners bill without a collaborating physician?
NPs with more than 3,600 hours of practice experience may practice without a written collaborative agreement under a law now extended to July 1, 2030. NPs below that threshold need a collaborative relationship with a physician. Either way, the NP enrolls and bills under their own NPI.
Get a free billing audit for your New York practice
We will review your recent claims and denials against New York payer rules and show you what can be recovered.
Nearby states
Primary sources
- CMS: Who are the MACs, A/B MAC Jurisdiction K (JK)
- NYS DOH Medicaid managed care enrollment, June 2026
- eMedNY: Guide to Timely Billing
- NY DFS OGC opinion on Insurance Law 3224-a
- NYSED: Practice Requirements for Nurse Practitioners
- NY Education Law 6902 (NY Senate)
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
Request your free practice audit
An RCM specialist typically replies within one business day.