Brooklyn-Based Revenue Cycle Management for Practices Across New York State
A2Z Medical Billing Services in New York, working out of Brooklyn. We aren’t a national vendor with a New York landing page. No-fault billing runs on a strict 45-day submission window that has nothing to do with standard health claims. eMedNY and Ambulatory Patient Group (APG) methodology govern Medicaid billing for hospitals and clinics in ways most billing companies have never had to learn. The downstate plan mix, Healthfirst, EmblemHealth, MetroPlus, shares almost nothing with the upstate mix built around Excellus and CDPHP. We work with independent practices, group practices, and no-fault and workers’ compensation providers across both New York City and upstate New York.
New York’s billing structure splits along more lines than any other state in this cluster. A practice moving between any two of these lines is really operating in two different systems.
Downstate and upstate run on almost entirely different commercial payer mixes. New York City and outlying counties are dominated by health plans like Healthfirst, EmblemHealth, MetroPlus Health (NYC public patients), Anthem, and Fidelis Care. Excellus is all-but unbroken in the Capital Region, Central New York, and largely controls much of the Finger Lakes; less so downstate (MVP Health Care claims that territory as well). A group with offices in both regions is contracting with two sets of payers that barely overlap.
No-fault is its own billing discipline. It isn’t a subset of commercial billing. It runs on its own forms, its own clocks, and its own dispute pathway through arbitration rather than a standard appeal. A biller who treats a no-fault claim like a commercial claim misses deadlines that don’t exist anywhere else in healthcare billing.
Medicaid billing runs through eMedNY, and outpatient and clinic claims price out under APG methodology rather than a standard fee schedule. This applies directly to Article 28, 31, and 32 facilities, hospitals, mental health clinics, and substance use disorder programs, each billing under its own rate codes.
Medicare adds a fourth layer. National Government Services processes Part A and Part B claims for Jurisdiction K, which covers New York, Connecticut, and the rest of New England. A group with locations in both New York and New Jersey deals with two entirely separate Medicare contractors, since New Jersey sits under Novitas in Jurisdiction L instead.
This is the single most expensive recurring error in New York billing. A bill submitted on day 46 can be denied outright, regardless of how clean the claim otherwise is.
A practice with a Manhattan office and an Albany office needs two separate sets of payer relationships instead of one.
Article 28, 31, and 32 institutional claims depend on the correct rate code and location identifier. Getting either wrong is a common and expensive error for clinic billers.
Few practices track the 30-day electronic and 45-day paper clocks closely enough to actually collect the interest they're owed.
Home care billing shifted when Public Partnerships LLC became the state's single fiscal intermediary in April 2025, replacing roughly 600 prior fiscal intermediaries.
Multiple managed care plans, each with its own authorization rules, competing for the same patient population.
Left alone, every one of these becomes the same problem: revenue sitting in aging AR with no clear path to recovery.
No-fault covers up to $50,000 in basic economic loss per person under Article 51 of the New York Insurance Law, regardless of who caused the accident. It runs on its own regulatory track entirely separate from standard health insurance billing.
Regulation 68 (11 NYCRR 65) sets the clocks. Written notice of claim is due within 30 days of the accident. Medical bills, submitted on Form NF-3, Verification of Treatment, are due within 45 days of the date of service. Miss either window and the insurer has grounds to deny the claim outright.
Once a bill is submitted, the insurer has 30 days to pay or deny it under Insurance Law § 5106(a). A denial comes on Form NF-10. An insurer that misses the 30-day window owes interest at 2 percent per month on the overdue amount. If the claim is denied and the provider disagrees, the dispute goes to arbitration through the American Arbitration Association, the forum New York’s Department of Financial Services designates under Regulation 68, filed on Form AR1.
No-fault AR needs its own workflow. A no-fault claim sitting in a general AR queue, tracked on the same cadence as a commercial claim, misses the clocks that actually govern it.
| Step | Deadline | Form | What Happens If You Miss It |
|---|---|---|---|
|
Notice of claim
|
30 days from the accident
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NF-2
|
Grounds for denial of the entire claim
|
|
Medical bill submission
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45 days from date of service
|
NF-3
|
Bill can be denied as untimely
|
|
Insurer pays or denies
|
30 days from proof of claim
|
NF-10 (if denied)
|
Insurer owes 2% monthly interest on the overdue amount
|
Two rules outside no-fault govern how fast a New York claim gets paid, and one governs workers’ compensation reimbursement specifically.
Prompt pay under New York Insurance Law § 3224-a requires an insurer to pay an undisputed claim within 30 days if submitted electronically, or 45 days if submitted on paper. A claim paid past that window accrues interest at 12 percent per year, whichever is greater than the corporate tax rate set by the state. The electronic-versus-paper distinction is a direct financial argument: submitting electronically shortens the clock by 15 days on every claim. When interest goes unpaid, a provider can file a complaint with the Department of Financial Services (DFS), which investigates and can fine the insurer directly.
Billing for workers’ compensation claims is performed on the CMS-1500, with fee schedules published by the New York Workers’ Compensation Board (WCB) and subject to WCB’s Medical Treatment Guidelines. Prior authorization for treatment outside those guidelines runs through the WCB Medical Portal.
| Rule | What It Requires | Citation | What It Means for Your Practice |
|---|---|---|---|
|
Prompt pay, electronic
|
Payment within 30 days
|
NY Ins. Law § 3224-a
|
Submitting electronically shortens your payment clock by 15 days
|
|
Prompt pay, paper
|
Payment within 45 days
|
NY Ins. Law § 3224-a
|
Paper claims carry a longer, slower clock
|
|
Prompt pay interest
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12% annual interest after the deadline passes
|
NY Ins. Law § 3224-a(c)
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Track aging by submission method; file a DFS complaint if interest goes unpaid
|
|
Workers’ compensation billing
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CMS-1500, WCB fee schedule, Medical Treatment Guidelines
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NY WCB regulations
|
Prior authorization for out-of-guideline treatment runs through the WCB Medical Portal.
|
eMedNY is New York’s Medicaid claims and provider enrollment system, administered by the NYS Department of Health’s Office of Health Insurance Programs (OHIP). Enrollment, revalidation, claim submission, claim status, and remittance all run through it.
Outpatient and clinic services are priced under Ambulatory Patient Groups (APGs), New York Medicaid’s own reimbursement methodology, classified and priced using 3M’s Grouper Pricer software. APGs apply to fee-for-service claims and, in many cases, to managed care claims as well.
Every one of these depends on the correct rate code and Locator ID on the institutional claim. Getting either wrong is a common and expensive error, since the claim can process at the wrong rate or reject outright rather than simply underpay.
Managed care add layer: Medicaid managed care, HARP (Health and Recovery Plans) for adults with serious behavioral health needs; Managed Long Term Care (MLTC), which includes dual eligibles and community-based long-term-care options; the Essential Plan covering those who just miss the threshold for medicaid as well marketplace based insurance/controller on-reimbursable plans in-between it- Child Health – Plus. Since April 2023, NYRx has operated as a fee-for-service Medicaid pharmacy benefit (outside of managed care).
On April 1, 2025, Home care billing became structurally different when Public Partnerships LLC (PPL) was designated the only statewide fiscal intermediary for the Consumer Directed Personal Assistance Program (CDPAP), under an amendment to Social Services Law § 365-f that replaced nearly six hundred prior fiscal intermediaries. Anyone billing CDPAP services needs a workflow built around PPL specifically. The prior fragmented system no longer applies. DMEPOS claims route separately through Noridian Healthcare Solutions, the DME MAC for Jurisdiction A, which includes New York.
Our reimbursements are based on the current Medicaid managed care roster, including Healthfirst, Fidelis Care, MetroPlus Health, EmblemHealth (formerly known as GHI), Anthem( formerly Empire BlueCross BlueShield, name changed January 1st of this year) for NYS Provider System Directory & Healthcare Providers – New York State Department of Heath MolinaHealthcareOfNewYork and UnitedHealthcareCommunityPlan.
Upstate New York runs on a different plan mix entirely, and we bill it directly rather than treating it as an afterthought to the city.
PHI moving through eMedNY, no-fault carrier systems, and commercial payer portals runs under the same security standard regardless of which system is on the other end.
Signed with every client before any PHI moves between systems.
Applied across every system handling patient data.
Staff access follows the HIPAA minimum necessary standard.
Regular review of access logs and workflows.
Not a national vendor with a New York page. A real office in New York, working New York's own rules.
The 45-day window, NF-3 and NF-10, and AAA arbitration are a dedicated workflow here. They're never an afterthought bolted onto commercial billing.
Article 28, 31, and 32 billing, rate codes, and Locator IDs handled the first time correctly.
One point of contact who knows your specific payer mix, downstate or upstate.
You see the same claim status and aging data we do.
