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Medical Billing Services in New York
A New York practice can bill four very different systems in one week: Medicaid fee-for-service, Medicaid managed care plans, no-fault auto insurers under a state fee schedule, and workers' comp, where the treating provider must usually be authorized by the Board. We bill remotely for New York practices and keep each track on its own rules.
- Medicaid fee-for-service and Medicaid Managed Care plans
- No-fault auto claims billed to the fee schedule
- Workers' comp care by Board-authorized providers, priced to the Board's schedules
New York Medicaid: eMedNY and managed care plans
Under New York law, the State Department of Health is the single state agency that supervises the Medicaid program. Medicaid has both fee-for-service and managed care: questions about submitting Medicaid claims go to eMedNY Provider Services, while claims for Medicaid Managed Care members follow the guidelines of the member's plan.
In practice, every Medicaid patient needs a quick check of which track they are on, because the same visit is billed to a different place with different rules depending on the answer.
Official sources: NY Social Services Law section 363-a (NY Senate) (external site), NYS Office of the Medicaid Inspector General: information for providers (external site)
No-fault auto and workers' comp: two fee-schedule systems
Both pay by schedule rather than by your charges, but enrollment and billing differ.
| Area | No-fault auto | Workers' compensation |
|---|---|---|
| Coverage | Owners must carry No-Fault (Personal Injury Protection) coverage to register a vehicle; it pays injured people's medical expenses. | Covers work-related injuries under the Workers' Compensation Board. |
| Who can treat | Any provider, billing the auto insurer. | Outside emergencies, most providers need Board authorization before they treat an injured worker. |
| Payment basis | Providers must bill under the no-fault fee schedules and cannot balance-bill the patient above them; the schedules are based on the Workers' Compensation Board schedules. | Payers must reimburse providers according to the Board's medical fee schedules. |
Official sources: NY Department of Financial Services: auto insurance (external site), NY DFS: Regulation 83 and the no-fault fee schedule (external site), NYS Workers' Compensation Board: becoming an authorized provider (external site), NYS Workers' Compensation Board: medical fee schedules (external site)
Surprise bills and out-of-network disputes in New York
Article 6 of New York's Financial Services Law protects patients from out-of-network emergency bills and from surprise bills, and when an insurer and a provider disagree about payment for those services, either one can submit the dispute to the Department of Financial Services for Independent Dispute Resolution.
For out-of-network practices, that makes documentation of the service, the setting and the patient's plan important from the first claim, so a dispute can be filed with a complete record if the payment is too low.
Official source: NY DFS: Independent Dispute Resolution Entity (IDRE) (external site)
Practices we typically see in New York
Many New York practices run several payer tracks side by side: Medicaid fee-for-service, with eMedNY Provider Services for claim questions, Medicaid Managed Care plans, no-fault auto claims and workers' compensation, each with its own enrollment, fee schedule and claim process.
How remote billing works for practices in New York
We work remotely in your practice management system and payer portals. Logins are issued by your practice, so you stay in control of access.
Step 1: Sort each patient into a payer track
Medicaid fee-for-service, managed care, no-fault, workers' comp or commercial, recorded at registration.
Step 2: Price no-fault and workers' comp claims
Auto and work-injury claims are billed to the applicable fee schedules, never to the patient above them.
Step 3: Confirm Board authorization
Workers' comp visits are scheduled with providers who hold Board authorization.
Step 4: Prepare disputes with the record
Low out-of-network payments for emergency or surprise-bill services are assembled for Independent Dispute Resolution.
Official sources for New York
Rules change. These are the agencies and contractors we check for the current requirements.
- CMS: A/B MAC Jurisdiction K (National Government Services) (external site)
- NY Social Services Law section 363-a (NY Senate) (external site)
- NYS Office of the Medicaid Inspector General: information for providers (external site)
- NY Department of Financial Services: auto insurance (external site)
- NY DFS: Regulation 83 and the no-fault fee schedule (external site)
- NYS Workers' Compensation Board: becoming an authorized provider (external site)
- NYS Workers' Compensation Board: medical fee schedules (external site)
- NY DFS: Independent Dispute Resolution Entity (IDRE) (external site)
Frequently asked questions
Who is New York's Medicare Administrative Contractor?
National Government Services, the Medicare Administrative Contractor for Jurisdiction K, which also covers the New England states.
Official source: CMS: A/B MAC Jurisdiction K (National Government Services) (external site)
Can we bill a no-fault patient for the difference above the fee schedule?
No. Providers must bill no-fault claims under the fee schedules and cannot balance-bill the patient for amounts above them.
Official source: NY DFS: Regulation 83 and the no-fault fee schedule (external site)
Does our provider need approval to treat workers' comp patients?
Usually yes. In most cases, yes. Apart from emergency care, a provider generally needs authorization from the Workers' Compensation Board before treating someone under a workers' comp claim.
Official source: NYS Workers' Compensation Board: becoming an authorized provider (external site)
Who handles Medicaid claim questions in New York?
Claim submission questions for New York Medicaid go to eMedNY Provider Services. Claims for patients in Medicaid Managed Care follow the member's plan guidelines.
What can we do about a low out-of-network payment for a surprise bill?
Either the insurer or the provider can submit the dispute to the Department of Financial Services for Independent Dispute Resolution, which applies set criteria to decide a reasonable fee.
Official source: NY DFS: Independent Dispute Resolution Entity (IDRE) (external site)
Related services and nearby states
Related services
Revenue Cycle Management
The whole cycle run as one process: patient access, coding, claims, payments, denials and patient balances, with shared KPIs.
Learn more about Revenue Cycle ManagementDenial Management
Denials worked by reason code and root cause, with corrected claims and appeals filed inside payer deadlines.
Learn more about Denial Management
Other states
New Jersey
NJ FamilyCare managed care, PIP auto claims under the DOBI fee schedule, the state workers' comp division and out-of-network arbitration.
Learn more about New JerseyPennsylvania
Medical Assistance through Physical HealthChoices and Community HealthChoices, the state prompt-pay regulation, workers' comp fee schedules and auto medical benefits.
Learn more about Pennsylvania
Juggling Medicaid, no-fault and workers' comp in New York?
Talk to us about running each payer track on its own rules, or start with a free billing audit.