Medical billing services in New York
The fastest way to lose money in New York is to bill every payer the same way. Fortunately, that's not how MedHeave works.
New York isn’t a place for one-size-fits-all billing. eMedNY, Medicaid managed care, the Essential Plan, and commercial payers like Fidelis, Healthfirst, MetroPlus, and EmblemHealth all follow different billing requirements.
MedHeave builds payer-specific workflows that adapt to the way your practice gets paid, whether you’re serving patients in the Bronx, Brooklyn, Albany, Rochester, Buffalo, or anywhere in between.
Our operational footprint
These aren't aspirational targets.
These metrics are what we deliver, consistently, across all practices and specialties we work with.
100K+
Monthly claims processed
15-25%+
Increase in monthly revenue
Under 10%
Denial rate
Under 40
AR Days
90%+
First-pass rate
97%+
Net collection rate
Why New York practices need specialized billing support
If your claims could choose a state to avoid, New York would be high on the list.
The hardest part about billing in New York isn’t the volume. It’s keeping up with how differently each payer expects to be billed. These are the gaps that follow.
Medicaid MCO billing is not the only problem
Fidelis Care, Healthfirst, MetroPlus, and EmblemHealth all operate under New York’s Medicaid Managed Care program, yet each runs its own prior auth requirements, coding rules, and documentation standards. Billing one MCO like another is a fast track to denials. With 6.7 million Medicaid and CHIP enrollees across these plans, errors don’t stay small for long.
eMedNY proficiency is non-negotiable
New York processes all Medicaid claims through eMedNY, the state’s electronic claims system. Submission errors, enrollment gaps, and edit failures in eMedNY don’t just delay payment; they reject claims outright. A billing partner without direct eMedNY experience isn’t just inefficient in New York; it’s a liability.
Credentialing delays are months of lost revenue
Getting credentialed with New York payers through CAQH and eMedNY enrollment takes time, and every week a provider isn’t credentialed is a week they can’t bill. For new practices or expanding groups in NYC’s fast-moving market, that delay creates a revenue gap that’s hard to recover from.
New York's payer diversity is relentless
NYC practices juggle dozens of active payers at once. That mix spans Medicaid MCOs, the Essential Plan, Medicare, and commercial carriers like Empire BCBS, UnitedHealthcare, Oscar, Aetna, and Cigna. Each carries its own edits, denial patterns, and documentation preferences. Without payer-specific expertise, claims leak through constantly.
Upstate practices are underserved and overstretched
Most billing partners targeting New York focus entirely on NYC. Practices in Albany, Syracuse, Rochester, and Buffalo face a different payer mix, more Medicare and commercial volume, and far fewer local billing resources. MedHeave serves all of New York, not just the five boroughs.
Medical billing services MedHeave provides in New York
We have built billing workflows New York actually needs, not the ones easiest to scale.
If all your claims in New York follow the same workflow, your billing probably has some catching up to do. Ours adapts to the payer, specialty, and practice instead of expecting the same workflow to do everything.
RCM
New York's revenue cycle runs through eMedNY, dozens of Medicaid MCOs, the Essential Plan, and a commercial market spanning Empire BCBS, UnitedHealthcare, Oscar, and Aetna simultaneously. We manage your full RCM workflow across every layer of New York's payer complexity so nothing falls through the cracks and every earned dollar makes it to collections.
Medical billing
From eMedNY Medicaid submissions to Essential Plan claims and commercial carrier billing across NYC's five boroughs and upstate markets, New York's billing workload is unlike any other state. We handle every payer on your panel with New York-specific precision so your practice gets paid without the denials that come from a less-prepared team.
Medical coding
New York's Medicaid MCO billing & high volume specialty practices demand accurate ICD-10 coding across complex encounters, procedure-heavy claims, and chronic care management codes that vary by payer. We code every service correctly the first time so New York's payer complexity never becomes a rejection in your eMedNY queue or a denial in your commercial AR.
Credentialing
Getting credentialed through CAQH for commercial payers and eMedNY enrollment for Medicaid in New York's fast-moving market creates revenue gaps that compound every week. We manage every credentialing step across Fidelis, Healthfirst, Empire BCBS, and Medicare so your providers are billing as fast as New York's system allows.
Prior authorization
New York's Medicaid MCOs and commercial carriers each run their own prior auth requirements that vary significantly across Fidelis, EmblemHealth, MetroPlus, and UnitedHealthcare. We manage every authorization proactively and payer-specifically so your patients aren't delayed and your claims don't come back denied for approvals your team didn't have bandwidth to chase.
Patient billing
New York's surprise billing protections and the federal No Surprises Act run in parallel, creating a compliance layer that most billing partners don't navigate correctly for out-of-network encounters. We build fully compliant patient billing workflows into every touchpoint so your New York practice collects what it's owed without regulatory exposure.
Denial management
With dozens of active payers across Medicaid MCOs, the Essential Plan, and commercial carriers, denial management in New York isn't one workflow, it's many. We track denial patterns per payer, appeal aggressively with New York-specific documentation strategies, and recover revenue that any average billing team would write off.
Workers' comp & no-fault billing
New York has one of the country's most complex workers' comp systems, with its own fee schedule, documentation requirements, and dispute resolution process through the New York State Workers' Compensation Board. We handle every workers' comp claim with the state-specific compliance and precision that keeps your payments on track and your practice out of disputes.
New York payers we work with
One payer's clean claim is another payer's rejection. Good thing we don't recycle workflows.
Every major payer in New York expects claims a little differently. MedHeave builds its workflows around those differences, whether you’re billing Medicaid MCOs, the Essential Plan, commercial plans, or Medicare.
Medicaid Managed Care Organizations
New York’s Medicaid MCOs aren’t interchangeable. Fidelis Care, Healthfirst, MetroPlus, and EmblemHealth each run distinct billing workflows, prior auth processes, and documentation requirements under the state’s Managed Care program. We maintain payer-specific knowledge for every MCO your practice bills so claims go out right and come back paid.
New York Essential Plan
With 1.2 million enrollees, the Essential Plan is one of New York’s largest coverage programs and one of the most overlooked by billing partners. We handle Essential Plan eligibility verification and claims submission correctly so this patient population stops costing your practice money in avoidable denials.
Empire BlueCross BlueShield
New York’s dominant commercial carrier with its own prior auth requirements and appeal processes. We manage Empire BCBS claims with the state-specific documentation strategies that actually move the needle on denials.
UnitedHealthcare, Aetna, and Cigna
Three of New York’s largest commercial payers, each with distinct coding preferences and authorization thresholds. We stay current on each carrier’s New York-specific policies so your commercial revenue doesn’t get eaten by preventable denials.
Oscar Health
A growing commercial presence in New York’s individual and small group market. We handle Oscar claims with the same precision as your larger commercial payers so no slice of your payer mix gets treated as an afterthought.
Medicare
High-volume across New York’s aging population, particularly in upstate markets and outer NYC boroughs. We handle standard Part B claims alongside complex chronic care and preventive billing codes so your Medicare revenue is fully captured every time.
Serving all of New York – NYC, Suburbs, and Upstate
We don't divide New York into 'the city' and 'everywhere' else.
Our billing workflows don’t change based on where your practice is located. MedHeave supports practices across New York, from Manhattan and Long Island to Albany, Rochester, Syracuse, and Buffalo.
Medicaid Managed Care Organizations
New York’s Medicaid MCOs aren’t interchangeable. Fidelis Care, Healthfirst, MetroPlus, and EmblemHealth each run distinct billing workflows, prior auth processes, and documentation requirements under the state’s Managed Care program. We maintain payer-specific knowledge for every MCO your practice bills so claims go out right and come back paid.
New York Essential Plan
With 1.2 million enrollees, the Essential Plan is one of New York’s largest coverage programs and one of the most overlooked by billing partners. We handle Essential Plan eligibility verification and claims submission correctly so this patient population stops costing your practice money in avoidable denials.
Empire BlueCross BlueShield
New York’s dominant commercial carrier with its own prior auth processes, coding requirements, and denial patterns. We manage Empire BCBS claims with the state-specific documentation strategies that actually move the needle on denials.
Medicare
High-volume across New York’s aging population, particularly in upstate markets and outer NYC boroughs. We handle standard Part B claims alongside complex chronic care and preventive billing codes so your Medicare revenue is fully captured every time.
Our specialties
Behavioral health isn't neurology. Your billing shouldn't pretend otherwise.
New York’s independent specialists operate across the country’s most diverse and demanding payer mix, from Medicaid MCOs in the Bronx to commercial-heavy panels in Manhattan and Medicare-dominant practices upstate. Whether you’re a pediatrics group in Queens navigating Healthfirst or a wound care practice in Buffalo dealing with Medicare documentation requirements, MedHeave bills every specialty with the New York-specific depth your revenue cycle depends on.
Behavioral health
In behavioral health, missing eligibility or session tracking can cost several visits, not just one. We stay ahead of authorization limits, benefit caps, telehealth changes, and co-pay structures so billing stays steady through care.
Podiatry
For podiatry billing, we make sure modifiers like 25 and RT/LT are accurate, services align with global periods and payer edits, and orthotics always meet payer-specific authorization and DME requirements before claims go out.
Urgent care
We handle urgent care billing across walk-ins, diagnostics, and procedures. From there, we track payer coding rules, facility contracts, authorizations, and eligibility checks so claims never get delayed or denied.
Orthopedic
We handle orthopedic billing, making sure procedures are authorized upfront, modifiers like LT/RT and bilateral are applied correctly, and surgical cases with implants are coded and billed to payer requirements for accurate reimbursement.
Cardiology
Cardiology billing often triggers NCCI edit denials, bundling issues, and global period violations when E/M services and procedures are billed together. We manage coding and modifier logic to reduce denials and boost payments.
DME
DME billing is handled by aligning orders, documentation, and delivery timelines with payer rules. We apply HCPCS coding, manage capped rentals, and enforce refill limits so claims are never denied for documentation paperwork.
Pediatrics
In pediatrics, we handle well visits and immunizations, making sure vaccine administration and VFC eligibility are correct, age-based coding stays accurate as well, so nothing gets missed, underbilled, or delayed at any visit.
Anesthesia
The accuracy of anesthesia billing depends on capturing start and stop times correctly. We ensure accurate time capture, apply base units and modifiers, and handle medical direction and concurrency so every unit is billed right.
Don’t see your specialty? We likely work in it.
Why choose MedHeave for medical billing in New York
We don't ask your practice to fit our workflow. We build the workflow around your practice.
New York isn’t just another state we happen to bill in. We bring eMedNY expertise, MCO-specific billing workflows, statewide coverage, and the operational depth independent practices need to navigate one of the country’s most demanding billing environments.
We know eMedNY, not just how to submit through it, but how to fix it when it pushes back
eMedNY proficiency isn't a checkbox for us. It's a core competency. We resolve eMedNY edits and rejections fast, keep your Medicaid claims moving, and prevent the submission errors that pile up into serious AR problems for practices whose partners don't know the system well enough.
We know every MCO by name and by rule
Fidelis, Healthfirst, MetroPlus, EmblemHealth, we don't treat them as interchangeable. We maintain payer-specific knowledge for every MCO your practice bills so claims are routed correctly, authorizations are secured in advance, and denials stop happening for reasons your current partner can't even explain.
We serve all of New York and mean it
Most billing partners say they cover New York but only think about Manhattan. We serve practices from Brooklyn to Buffalo with the same depth of knowledge and the same level of attention. If you're upstate and underserved by partners who don't know your market, that changes with MedHeave.
Credentialing that doesn’t leave your providers sitting on the sidelines
Every week a provider isn't credentialed is lost revenue you can never recover. We manage CAQH and eMedNY enrollment from start to finish, follow up relentlessly, and get your providers active and billing as fast as New York's system allows.
Full visibility into your revenue cycle, no chasing required
You'll receive clear, regular reporting on claims status, AR aging, denial trends, and payer-specific performance across your entire book. You'll always know exactly where your money stands and what we're actively doing about it.
FAQs
Choosing a billing partner shouldn't require a leap of faith. Start with these questions.
Thinking about outsourcing your medical billing in New York? Most New York practices ask us some version of these questions before they decide to work with us.
Does MedHeave handle Medicaid MCO billing for all major New York plans?
Yes. We bill across every major MCO, including Fidelis Care, Healthfirst, MetroPlus, and EmblemHealth, with payer-specific routing, prior auth management, and documentation workflows for each one.
Is MedHeave proficient with eMedNY submissions?
Absolutely. We submit all New York Medicaid claims through eMedNY, resolve edits and rejections fast, and keep your Medicaid revenue moving without the delays that come from partners still learning the system.
Can MedHeave handle Essential Plan billing?
Yes. We manage Essential Plan eligibility verification and claims submission so New York’s 1.2 million Essential Plan enrollees stop being a billing blind spot for your practice.
Does MedHeave serve practices outside NYC, upstate, Long Island, Westchester?
Yes. We serve independent practices across all of New York, from the five boroughs to Albany, Rochester, Syracuse, and Buffalo, with the same depth of knowledge regardless of where your practice sits.
Can MedHeave manage credentialing through CAQH and eMedNY?
Yes. We handle the full credentialing process across CAQH for commercial payers and eMedNY for Medicaid enrollment, following up at every step until your providers are active and billing.
Does MedHeave support telehealth billing in New York?
Yes. We stay current on every payer’s telehealth reimbursement policies across Medicaid MCOs and commercial carriers, so your virtual care revenue is captured with the same precision as your in-person claims.
Your billing has been improvising.
New York isn't the place for that.
New York’s billing environment doesn’t reward guesswork. Let MedHeave take a look before it costs you more.
