Medical Billing Services in New York

eMedNY (Electronic Medicaid New York) is the state’s Medicaid claims processing system, operated by DXC Technology under contract with the New York State Department of Health. All fee-for-service Medicaid claims must submit through eMedNY for adjudication and payment. Providers must maintain active enrollment in eMedNY for every rendering and billing NPI. OmniMD manages eMedNY enrollment, 837P/837I claim submission, and 835 ERA remittance reconciliation for all New York Medicaid providers.

New York Medicaid requires initial claim submission within 90 days of the date of service for most claim types. Exceptions exist for coordination of benefits situations, retroactive eligibility, and documented delays. Medicare has a 12-month timely filing window. Most commercial plans operating in New York require submission within 90 to 180 days depending on the carrier contract. OmniMD tracks every claim against its filing window and escalates outstanding Medicaid claims before they reach 60 days.

New York Insurance Law Section 3224-a requires health insurers to pay or deny electronic claims within 30 days of receipt (45 days for paper claims). Claims that are adjudicated but paid late accrue interest at 2% per month, which equals 24% per year. OmniMD monitors adjudication timelines for all commercial and MCO claims in New York and pursues prompt-pay interest charges on eligible late payments as part of standard A/R follow-up. The full text of Section 3224-a is published by the New York Department of Financial Services.

Under New York Insurance Law Article 51, auto insurance policies must carry at least $50,000 in PIP coverage. Providers treating injured patients must submit claims within 45 days of the date of service. The insurer has 30 days to pay or deny after receiving a complete claim. Bills are governed by the NY DFS No-Fault Fee Schedule. OmniMD handles No-Fault claim submission, PIP exhaustion verification, denial appeals, and independent dispute resolution (IDR) arbitration support for No-Fault billing practices.

The NY Workers’ Compensation Board requires providers to submit treatment documentation using WCB Form C-4. Treatment must comply with New York’s Medical Treatment Guidelines (MTGs); treatment outside the MTGs requires prior authorization from the liable carrier. All bills must comply with the NY WCB Fee Schedule, which is updated annually. OmniMD submits WC claims to the liable carrier, tracks authorization requirements, and resolves IME objections and carrier denials through the WCB dispute process.

OmniMD is credentialed and actively billing with the full NYC MCO panel: Fidelis Care, Healthfirst, MetroPlus Health Plan, UnitedHealthcare Community Plan, Wellcare of New York, Empire BlueCross BlueShield, EmblemHealth (GHI and HIP plans), Aetna, Cigna, and Humana. We also handle eMedNY fee-for-service Medicaid and No-Fault billing for NYC practices treating accident injury patients.

Yes. OmniMD is credentialed with CDPHP (Capital District Physicians’ Health Plan), Independent Health (Buffalo and Western New York), Excellus BlueCross BlueShield (central and western New York), MVP Health Care, and the NY State Health Insurance Program (NYSHIP) for state employee billing. Our billing team understands upstate New York’s regional payer preferences and authorization workflows, which differ significantly from the NYC MCO market.

New York Financial Services Law Sections 3238 through 3242 (the NY Surprise Bill Law) predates the federal No Surprises Act and applies to out-of-network services at in-network facilities. It requires providers to disclose out-of-network status, limits patient cost-sharing, and establishes an IDR process for payment disputes. OmniMD ensures billing documentation meets NY Surprise Bill disclosure requirements and provides IDR arbitration support when payment disputes arise.

Dual-eligible patients in New York are enrolled in both Medicare and Medicaid. Medicare is the primary payer; eMedNY Medicaid is secondary for cost-sharing wrap-around. OmniMD submits claims to Medicare first, posts the Medicare remittance, then cross-files the balance to eMedNY using the correct crossover claim procedures. This sequencing prevents both underpayment and compliance risk from billing Medicaid before Medicare.

The New York Office of the Medicaid Inspector General (OMIG) audits, investigates, and recovers overpayments from Medicaid providers across New York State. Providers billing more than $500,000 per year in Medicaid services must maintain a written compliance program with specific mandatory elements. OmniMD supports billing compliance documentation, internal audit preparation, and OMIG data request responses alongside standard RCM services.

Most New York practices transitioning to OmniMD see measurable AR reduction within 60 to 90 days. The primary drivers are pre-submission scrubbing (which cuts first-submission denials), same-day payment posting, and systematic denial follow-up at 30, 60, and 90 days. Practices with significant No-Fault or WCB legacy AR backlogs typically see larger initial reductions as those aged claims are worked and resolved.

Yes. The New York State Department of Health’s VBP roadmap requires Medicaid MCOs to shift an increasing share of payments to value-based arrangements. OmniMD supports practices in tracking quality measures tied to VBP contracts, submitting supplemental data for population health incentives, and coding encounters to capture the clinical data MCOs use for VBP performance scoring.