Medical Billing
Services in New York
We help New York practices reduce denials, stay compliant with NY
Medicaid rules, and improve cash flow with specialty-focused billing support.
HIPAA Compliant
NY Medicaid Expertise
98% Clean Claim Rate
Challenges New York
Practices Face
New York has one of the most complex payer landscapes in the country. High claim volume, strict prior auth rules, and fast-changing Medicaid requirements mean your billing must be accurate, fast, and specialty-aligned.Most general billing companies cannot handle cardiology’s intensity, leading to:
High denials from Fidelis Care & HealthFirst
Modifier-sensitive rules from EmblemHealth / GHI
Eligibility issues across NYC & Long Island
Strict documentation requirements from MetroPlus
Complex Medicare claims handled by NGS (MAC)
Heavy payer mix differences between Upstate vs NYC practices
We help you navigate it all smoothly.
Complete Billing Support
Built for NY Clinics
Medical
Billing
Clean claims, faster reimbursements, and billing accuracy.
Medical
Coding
Accurate ICD-10, CPT, and HCPCS coding with specialty-trained coders.
Billing
Audit
Identify hidden revenue leaks instantly
A/R
Follow-Up
Aggressive follow-up on 30/60/90+ day claims to reduce aging AR.
Credentialing &
Enrollment
Fast payer enrollments, CAQH updates, and NPI support.
State Licensing
Support
Hassle-free provider licensing and renewals across multiple states.
Denial
Management
Fix root causes, recover revenue, and prevent future denials.
Billing Platforms & Clearinghouses
We Work With in New York
Fully compatible with New York’s most-used billing systems.
Our billing engine is designed to integrate smoothly with any
EMR, PMS, or clearinghouse used in New York.
Specialties We Serve Across New York
We support 100+ clinics across NY in specialties including:
New York–Focused
Billing Intelligence
New York’s payer rules, Medicaid policies, and claim behavior are unlike any other state.
Our team uses region-specific workflows built around real payer data, denial trends, and
specialty patterns across NYC, Long Island & Upstate
Experienced with Fidelis,
HealthFirst, MetroPlus, MVP, EmblemHealth, UHC,
Aetna, BCBS NY
Understand strict Medicaid documentation
rules
Faster enrollment for NY Medicaid &
commercial plans
Strong coding accuracy for high-volume
specialties
Dedicated biller for your New York region
Transparent reporting with denial root-cause
analysis
Your practice gets predictable revenue every month.
New York Medicaid
& Medicare Rules
NY Medicaid Billing Requirements
Prior authorization is required for many high-cost services
Strict limits on visit frequency for some specialties
Documentation must match clinical notes exactly
Claim filing deadline: 90 days for Medicaid Managed Care
OON billing is heavily restricted
NY Medicare (NGS MAC) Rules
Medicare claims in New York are processed by:
National Government Services (NGS) Common issues:
Modifier 25
misuse
Bundling
errors
Conflicts
with NCCI
edits
We fix these before submission.
Common Claim Denials
in New York
Denial Code
CO-197
CO-16
CO-109
PR-1
CO-45
CO-50
Issue
Missing/invalid authorization
Missing info
Not covered
Deductible
Exceeds fee schedule
Not medically necessary
Reason in Cardiology
HealthFirst, Fidelis require a strict PA
High in NYC clinics
Medicaid Managed Care is strict
Medicare NGS
NY Medicaid structured pricing
MetroPlus/Emblem sensitive
Fix
Submit PA + attach notes
Correct demographics + eligibility
Pre-verify plan + diagnosis
Collect upfront + verify Part B
Adjust & rebill
Add detailed notes + appeal
Major New York Payers
We Bill For
Payer Name
Fidelis Care
HealthFirst
MetroPlus
EmblemHealth (GHI/HIP)
MVP Health Care
UnitedHealthcare NY
Aetna NY
BCBS NY
Type
Medicaid
Medicaid
Commercial
Commercial
Commercial
Commercial
Commercial
Commercial
Notes
High claim volume in NY
Strict PA rules
Modifier-sensitive
Bundling common
Upstate NY major payer
Frequent coding edits
Precert needed
High in Upstate + NYC
Cities We Serve
in New York
New York City
Buffalo
Yonkers
Rochester
Syracuse
Albany
New Rochelle
Mount Vernon
Schenectady
Counties We Serve
in New York
Kings
Queens
New York
Suffolk
Nassau
Queens
Westchester
Erie
Monroe
Richmond
Onondaga
Orange
Performance Highlights
Our billing engine is built for speed, precision, and financial
consistency — designed specifically for New York’s payer landscape.
98%+ Clean Claim
Rate
Fewer reworks, faster
reimbursements
30–50% Reduction
in Denials
Root-cause corrections
from day one
Specialty-Focused
Coders
NY payer–aligned CPT/
ICD accuracy
HIPAA-Compliant
Workflow
Secure handling of
every encounter
Real-Time Revenue
Dashboards
Full visibility into claims,
A/R & collections
Our Billing Workflow for New
York Clinics
01
Eligibility Verification
& Medicaid Checks
02
Coding & Charge
Entry
03
Clean Claim
Review
04
Submission to
Clearinghouse
05
A/R Follow-Up
06
Denial
Management
07
Monthly Revenue
Reports
Ready to Improve Your New York
Practice Revenue?
Let our billing team optimize your claims, fix denials, and improve collections.
What New York Providers
Say About Us
Dr. Emily S.
Dermatology
“They understand specialty coding better than most in-house teams.”
Laura P.
Urgent Care
“We recovered thousands in lost AR. Reporting is clean, simple, and accurate.”
Dr. Michael R.
Cardiology
“Collections improved within 60 days. Their denial management is the best we’ve seen.”
Dr. Sofia M
Behavioral Health
“Behavioral health denials dropped massively. Their team knows payer rules inside out.”
Dr. Emily S.,
Dermatology
“They understand specialty-specific coding better than most in-house coders.”
Laura P.,
Urgent Care
“We recovered thousands in lost A/R within weeks. Reporting is clean and accurate.”
Dr. Michael R
Cardiology
“Collections increased in the first month. Their denial correction is faster than any team we’ve used.”
FAQ for New York Providers
Yes, we work with solo providers, group practices, urgent care centers, outpatient clinics, labs, and multi-location facilities across NY.
Absolutely. We manage enrollment and revalidation with Fidelis Care, HealthFirst, MetroPlus, EmblemHealth/GHI, MVP, Medicare, and all major commercial plans.
Yes, including Fidelis, HealthFirst, MetroPlus, MVP, WellCare, and NYS Medicaid (FFS + Managed Care).
Yes. Most NY providers see a 30–50% reduction in denials within 60–90 days.
We integrate with Epic, eClinicalWorks, Athenahealth, DrChrono, AdvancedMD, Kareo/Tebra, NextGen, Allscripts, Practice Fusion, and more.
Yes, with aggressive follow-up at 30, 60, and 90+ days, including appeals and payer-specific denial resolution.
We support 20+ specialties, including cardiology, urgent care, behavioral health, pediatrics, OBGYN, neurology, dermatology, orthopedics, pain management, and more.
Yes, including Fidelis Care, HealthFirst, MetroPlus, EmblemHealth, MVP, Medicare, and commercial plans.
Yes. We work inside your EMR, PMS, and clearinghouse with no workflow disruption.
Credentialing setups: 1–3 weeks
Existing credentialed providers: Go live in 3–5 days
Address
4309 Schubert, Colleyville Texas, TX 76034
Phone Number
(737) 787 2147
Business Hours
Monday – Friday: 08.00 – 17.00 Saturday: 09.00 – 12.00
