New York billing is defined by strict rules and tight deadlines. Medicaid managed care plans vary by county, documentation requirements are exacting, and New York Medicaid’s timely filing window is short, 90 days from the date of service. A practice that bills loosely in New York doesn’t just get denials; it runs out of time to fix them.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for New York practices of every specialty, built around the state’s actual payers and rules.
New York’s payer landscape
New York Medicaid is delivered largely through Medicaid Managed Care plans, which vary by county. Major plans include Fidelis Care, Healthfirst, MetroPlusHealth, EmblemHealth, Empire BlueCross BlueShield HealthPlus, UnitedHealthcare Community Plan, Molina Healthcare, MVP Health Care, Excellus BlueCross BlueShield, and CDPHP. Commercial coverage runs through Empire Blue Cross Blue Shield, Aetna, Cigna, Humana, and UnitedHealthcare, alongside Medicare.
Two New York rules deserve special attention. First, Medicaid managed care claims generally must be submitted within 90 days of service, so slow follow-up directly becomes lost revenue. Second, documentation must match clinical notes exactly. New York payers scrutinize the match between what was documented and what was coded, and out-of-network billing is heavily restricted.
What MedPlus RCM handles for New York practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with Medicaid managed care plans, commercial payers, and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation, inside the filing window.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve practices statewide, New York City, Buffalo, Rochester, Syracuse, Albany, and Long Island, across specialties including primary care, mental and behavioral health, cardiology, orthopedics, dermatology, and physical therapy.
Results New York practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
What is New York’s Medicaid timely filing deadline?
New York Medicaid generally requires submission within 90 days of the date of service. That makes prompt claim submission and fast denial follow-up essential; both are built into our process.
Do you work with New York Medicaid managed care plans?
Yes. We bill plans including Fidelis Care, Healthfirst, MetroPlusHealth, EmblemHealth, Empire BlueCross BlueShield HealthPlus, UnitedHealthcare Community Plan, Molina, MVP, Excellus, and CDPHP, as well as commercial and Medicare plans.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your New York practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
