Professional Medical billing services in New York
SwiftCare Billing provides medical billing services in New York built around the payers you actually bill: Medicaid managed care plans, National Government Services for Medicare, and Empire BlueCross BlueShield. Pricing starts at 3% of collections. Month-to-month, 30 days’ notice.
- 98.4% Clean Claim Rate
- 175+ Providers
- 50+ Specialties
- 12+ Years
New York medical billing at a glance
| Item | New York |
|---|---|
| Medicaid program | New York Medicaid, run by the State Department of Health (DOH) |
| Medicaid enrollment | About 6.4 million overall; about 4.4 million in mainstream managed care (May 2026) |
| Medicaid health plans | More than a dozen, varying by county: Affinity by Molina, Anthem Blue Cross Blue Shield, CDPHP, EmblemHealth, Excellus BCBS, Fidelis Care, Healthfirst, Highmark BCBS of Western NY, Independent Health, MetroPlus, Molina, MVP, UnitedHealthcare |
| Fee-for-service portal | eMedNY |
| Medicare A/B contractor | National Government Services (NGS), Jurisdiction K |
| Medicare DME contractor | DME MAC Jurisdiction A |
| Medicare timely filing | 12 months from date of service |
| Medicaid timely filing | 90 days from date of service; later claims need a delay reason code |
| Commercial prompt pay | 30 days electronic, 45 days paper (Insurance Law 3224-a) |
| Surprise billing | State law with independent dispute resolution (Financial Services Law Article 6), plus the federal No Surprises Act |
| Auto accident claims | No-fault (Insurance Law Article 51); fees follow the workers’ comp schedule |
| Workers’ compensation | Workers’ Compensation Board medical fee schedule |
Why billing in New York takes state-specific work
Ninety days is all you get on Medicaid
New York Medicaid wants claims within 90 days of the date of service. Miss it and you need an approved delay reason, and some of those claims must go on paper with a form attached. Most practices don’t track this closely. We flag every Medicaid claim that’s heading toward day 90.
The plan list changes by county
There’s no single New York Medicaid plan. A patient in Brooklyn might have Healthfirst or MetroPlus. One in Buffalo might have Highmark or Independent Health. A claim sent to the wrong plan is a denial you didn’t need. We verify the plan before every visit.
No-fault claims run on a 30-day clock
Insurers must pay or deny a no-fault claim within 30 days of proof of loss. Fees follow the workers’ compensation fee schedule under Regulation 83. If a carrier misses its window, it can lose its fee-schedule defense. We track the clock on every claim.
Surprise bill disputes got a new rule in August 2026
New York runs its own dispute process for surprise bills, and the federal rules sit beside it. Starting August 26, 2026, DFS requires both sides to pay the dispute entity’s fee, with the winner refunded within 30 days. Disputes now cost money up front. We decide which claims are worth taking that route.
- Our Services
Our medical billing services in New York
Our medical billing services provider team handles the whole revenue cycle, or any one step of it. That includes medical billing and coding from AAPC-certified coders, so you don’t need to hire a separate coding company in New York.
We confirm the exact Medicaid plan, not just active coverage
Codes checked against NGS edits and each plan’s rules
Claim submission
Claims scrubbed first; Medicaid claims watched against the 90-day limit
Each denial logged by payer and reason, then the cause fixed
Commercial claims past day 30 get chased
Payments posted, statements patients can read
Requests tracked plan by plan
Outsourced physician billing solutions in New York State
You send us the encounter. We handle the rest: eligibility, coding, submission, denials and follow-up. One team, one named account manager, one monthly report. We work in your EHR, so nothing changes for your staff.
Professional medical revenue cycle management services in New York
Billing is only part of cash flow. We also look at the front end, where most denials start: registration, eligibility and authorizations. When the front end is clean, there’s less to fix later.
Medical billing support for independent clinics in New York
Independent clinics often run billing on one person’s shoulders. We act as your back office, and we’re third-party only on paper. You always know who’s working your claims.
Medical credentialing and payer enrollment in New York
You can’t bill until you’re enrolled. New York requires every Medicaid managed care network provider to be enrolled with the state Medicaid program as well. Without it, a plan can remove you from its network. Our medical credentialing services cover state enrollment and each plan.
- NPI check and an attested CAQH profile
- Medicare enrollment through PECOS, processed by NGS
- NY Medicaid enrollment through eMedNY
- Credentialing with each Medicaid plan you choose
- Commercial plan applications, including Empire BlueCross BlueShield
- Revalidation reminders (eMedNY posts each provider's next revalidation date)
Payers we bill in New York
We bill Medicare, Medicare Advantage, Medicaid plans and commercial carriers like Empire BlueCross BlueShield. [CONFIRM full commercial list.] We also bill no-fault auto and workers’ compensation carriers.
Here’s how the rules differ by payer:
| Payer type | Rule that changes your billing |
|---|---|
| Medicaid | Claims due in 90 days; later ones need a delay reason code |
| Commercial health plans | Pay clean claims in 30 days (electronic) or 45 days (paper) |
| No-fault auto | Pay or deny in 30 days; fees follow the workers’ comp schedule |
| Workers’ compensation | Board medical fee schedule |
| Out-of-network surprise bills | State dispute process; both parties pay the fee from Aug. 26, 2026 |
Shopping around? Here’s how to compare medical billing companies in New York. Ask each one how they handle the rules above.
Medical specialties we bill for in New York
We bill 50+ specialties. New York practices often come to us in family practice, paediatrics, mental health, physical therapy, chiropractic and cardiology. Practices that see auto accident patients benefit most from no-fault experience.
EHR and practice management systems we work with
We support 80+ systems and work inside yours: Epic, athenahealth, eClinicalWorks, Tebra (Kareo) and AdvancedMD, among others. Nothing to migrate. We connect to your clearinghouse and eMedNY.
Where we work in New York
New York City (all five boroughs), Long Island, Yonkers, White Plains, Albany, Syracuse, Rochester, Buffalo, Binghamton and Utica, and the towns in between. SwiftCare Billing serves providers in all 50 states.
HIPAA-compliant medical billing services in New York
Billing means handling patient data all day. Here’s what to expect from any vendor, us included.
- A signed BAA. HIPAA requires a business associate agreement before a vendor touches your PHI (45 CFR 164.504(e)). We sign one first.
- Breach notice. A business associate must tell you about a breach without unreasonable delay, and within 60 days of discovery at the latest (45 CFR 164.410). Your BAA can set a shorter deadline, and we'd follow it.
- Limited access. Our U.S.-based staff see what a billing task needs, not the whole chart.
- Your data stays yours. If you leave, your claims and patient accounts go with you.
Results New York practices can check
98.4% clean claim rate across SwiftCare Billing clients
Onboarding in 7 to 14 business days
Free audit report in 5 business days
Medical billing pricing for New York practices
Pricing starts at 3% of collections. Most practices land between 3% and 8%, depending on specialty, volume and payer mix. No long-term contract. See pricing. If you run a private practice, a free audit shows real numbers first. It’s the lowest-risk way to see what a reliable medical billing company for healthcare providers in New York can do for you.
How onboarding works
1. Free audit of your recent claims, written report in 5 business days
2. Access to your EHR and clearinghouse
3. Enrollment check with NGS, eMedNY and each plan you bill
4. Fee schedule and contract review
5. Go-live in 7 to 14 business days, then monthly reporting
Ready to Turn Your Revenue
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Frequently asked questions about medical billing in New York
How much does medical billing cost in New York?
It starts at 3% of collections. Most practices pay 3% to 8%. A free audit gives you a quote based on your own claims, not a guess.
Which New York Medicaid plans do you bill?
The plans in your county: Healthfirst, Fidelis Care, MetroPlus, Affinity, MVP, Excellus, UnitedHealthcare and others. We also handle credentialing with each one.
Who processes Medicare claims in New York?
National Government Services, as the A/B MAC for Jurisdiction K. DME claims go to DME MAC Jurisdiction A. Medicare claims must be filed within 12 months.
How long do I have to file a New York Medicaid claim?
Ninety days from the date of service. Later claims must carry an approved delay reason code, and some need paper filing.
How fast must New York insurers pay?
Within 30 days for clean electronic claims and 45 days for paper ones. Self-funded plans follow federal law instead.
Do you bill no-fault auto claims?
Yes. Insurers must pay or deny within 30 days, and fees follow the workers’ comp schedule.
Do you sign a business associate agreement?
Yes, before we access anything. HIPAA requires it, and it sets breach-notice terms.
Can you work inside our EHR?
Yes. We support 80+ systems, and you keep yours.
Talk to a billing team that knows New York Medicaid
Tell us which Medicaid plans and commercial payers you bill. We’ll review your recent claims and send a written report within 5 business days.