Physician Billing for New York Practices

We handle medical billing for physicians of every model across the state — solo independent physicians, single- and multi-specialty groups, IPAs and delegated medical groups, physician-owned surgical and procedural practices, hospital-affiliated faculty practice plans, office-based ambulatory physicians, telehealth physician groups, and locum or coverage physicians from New York City and Yonkers to Buffalo, Rochester, and Syracuse. New physicians joining an established New York group get credentialing, CAQH, and PECOS enrollment tracked from the offer letter forward, so the first claim is billable on day one instead of parked in a holding queue. Groups billing across several sites of service get consistent place-of-service handling so office, hospital-outpatient, and inpatient rates are never crossed; procedural practices get global-period tracking that separates bundled post-op care from genuinely billable visits; and locum physicians get the reassignment and Q6 handling that keeps temporary coverage from generating denied claims. Whatever the practice model, the goal stays the same: every eligible encounter captured, coded to the level the record supports, and paid at the correct New York rate.

New York runs one of the country's largest Medicaid programs, and most enrollees receive care through mainstream Medicaid Managed Care plans — Fidelis Care, Healthfirst, MetroPlusHealth, UnitedHealthcare, Anthem HealthPlus, and MVP among them — each with its own paneling and prior-auth rules. Confirming which managed-care plan a member carries, and that the physician is enrolled with it, is the surest way to keep a claim from denying before it is adjudicated. Medicare Part B is administered by National Government Services, with New York's professional-fee claims split between downstate and upstate processing, so local coverage determinations and conversion-factor changes reset the fee schedule each year.

Commercially, the market is deep and regional: Empire Blue Cross Blue Shield and UnitedHealthcare lead downstate, EmblemHealth is a New York City fixture, and Excellus BlueCross BlueShield and MVP dominate large stretches upstate, alongside Aetna and Cigna statewide. Medicare Advantage penetration is high across the five boroughs and the mid-size markets, so prior authorization and retrospective review touch a real share of the schedule. Between the anchor systems — Northwell Health, Mount Sinai, NYU Langone, and NewYork-Presbyterian downstate, the University of Rochester and Kaleida Health upstate — sit thousands of independent single- and multi-specialty groups and IPAs that own their professional-fee revenue cycle outright. For those practices, revenue is protected by verifying plan and enrollment before the visit, securing MA authorizations, and defending high-level established-patient E&M with documentation that stands on its own.

In a market this large, preventable denials scale with volume — one repeating error across a full New York City schedule quietly outweighs any single large write-off. These are the leaks we close first.