Medical billing services built for New York practices that need real local expertise
CureMed is a top outsourced medical billing company serving cardiologists, orthopedic surgeons, psychiatrists, and specialty practices across New York City, Buffalo, Rochester, Syracuse, and Albany. From solo practitioners to multi-provider groups, our team brings Empire BCBS, Fidelis Care, and Healthfirst expertise, backed by certified coders who understand NY Prompt Pay Law and MMIS Medicaid enrollment.
New York Payer Battle Card
A practical look at how each major New York insurance payer handles your claims. New York has one of the densest healthcare markets in the country with strong Medicaid managed care presence. See market share, denial rates, payment timelines, and peer-to-peer win rates from actual New York medical billing operations.
Empire BlueCross BlueShieldEmpire BCBS · Anthem Commercial + Medicare Advantage
28%
▾
Strengths: Largest commercial payer in New York with strong prompt payment compliance under NY Insurance Law. Direct EDI integration through Availity available for most practices.
Denial patterns: Prior authorization denials on high-cost imaging, behavioral health, and molecular diagnostics. Frequent bundling edits on E/M plus procedure same-day encounters.
Best practice: Submit prior authorizations 5 business days before service through Empire provider portal. Use Availity for real-time authorization status.
CureMed advantage: Live Empire BCBS denial pattern tracking with direct portal integration. Certified team on both commercial and Medicare Advantage Empire plans.
UnitedHealthcare New YorkUHC · Commercial + Medicare Advantage
18%
▾
Strengths: Strong Medicare Advantage presence throughout New York. Reliable Optum Pay integration for claim submission and remit processing.
Denial patterns: Aggressive prior auth denials on molecular pathology and complex imaging. Frequent CO-197 denials on outpatient procedures. Medicare Advantage strict on skilled nursing documentation.
Best practice: Peer-to-peer requests within 24 hours of denial. Use UHC clinical criteria portal for medical necessity language. Detailed documentation required for MA members.
CureMed advantage: Dedicated UHC New York appeals specialists with real-time medical necessity language database. 56 percent peer-to-peer win rate.
Fidelis CareFidelis · Centene NY Medicaid + Marketplace
14%
▾
Strengths: Largest not-for-profit Medicaid managed care organization in New York. Broad member base across Medicaid, Child Health Plus, and Essential Plan.
Denial patterns: Prior authorization required for most specialty services. Slow appeals process (typically 30-45 days). Aggressive on out-of-network specialty referrals.
Best practice: Submit prior authorizations 10 business days before service via Fidelis provider portal. Include comprehensive clinical documentation upfront.
CureMed advantage: Fidelis Care appeals specialists on team with MMIS portal integration. Tracked prior auth workflow with 5-day escalation triggers.
HealthfirstHealthfirst · NYC Metro Medicaid MCO
12%
▾
Strengths: Largest Medicaid managed care organization in NYC metro area. Strong provider network across the five boroughs plus Long Island and Westchester County.
Denial patterns: Prior authorization required for imaging, specialty referrals, and behavioral health. Documentation requirements strict for HARP (Health and Recovery Plan) members.
Best practice: HARP members require enhanced clinical documentation. Submit prior auths through Healthfirst provider portal with detailed medical necessity language.
CureMed advantage: Healthfirst HARP specialists on team with dedicated NYC metro workflow. Behavioral health billing expertise for Medicaid managed care population.
Aetna New YorkAetna · CVS Health Commercial
10%
▾
Strengths: Strong commercial PPO presence throughout New York, particularly in NYC metro. Better than average for modifier acceptance and complex specialty billing.
Denial patterns: Frequent Modifier 25 audits on E/M plus procedure same-day. Strict documentation for behavioral health services. Aggressive on multi-provider billing at same TIN.
Best practice: Documentation must show separate identifiable service for Modifier 25. Behavioral health notes require exact session times.
CureMed advantage: Certified coders trained on Aetna New York Modifier 25 audit patterns. Automated audit-ready documentation checks with behavioral health templates.
MetroPlus Health PlanMetroPlus · NYC Public Hospital MCO
10%
▾
Strengths: NYC Health + Hospitals affiliated managed care organization. Serves Medicaid, Child Health Plus, HARP, MetroPlus Gold (Essential Plan), and Medicare.
Denial patterns: Slow appeals process (typically 45 days). Prior authorization required for most specialty services. Documentation requirements strict for HARP members.
Best practice: Submit prior authorizations 10 business days before service via MetroPlus provider portal. Weekly denial tracking essential for pattern identification.
CureMed advantage: MetroPlus appeals specialists with dedicated workflow for NYC public hospital network. Weekly denial pattern reports with corrective workflow.
EmblemHealthEmblem · NYC Commercial + Medicare Advantage
8%
▾
Strengths: Strong NYC metro commercial presence. Combines GHI and HIP legacy plans with unified provider network. Reliable claim processing for city and state employees.
Denial patterns: Documentation requirements strict for behavioral health services. Prior auth denials on specialty referrals and complex imaging. GHI plan denials frequent on out-of-network coordination.
Best practice: Verify GHI vs HIP plan status before every visit. Submit prior auths through Emblem provider portal with clinical justification.
CureMed advantage: Emblem specialists with GHI and HIP plan expertise. Automated eligibility verification workflow for NYC employer group coverage.
5 New York laws that affect your billing every day
New York has some of the most detailed medical billing regulations in the country. From the NY Prompt Pay Law to IPRO external reviews, here is what applies to your practice and how our outsourced billing services handle each.
NY Prompt Pay Law
Insurers must pay clean electronic claims within 30 days and paper claims within 45 days. Late payment triggers 12 percent annual interest penalty. Applies to all commercial payers regulated by New York DFS.
Surprise Billing Protection
Patients receiving emergency services or scheduled services at in-network facilities cannot be billed above in-network cost-sharing. Independent Dispute Resolution (IDR) process available for provider-payer disputes.
Independent Peer Reviews
New York providers can request external appeals through IPRO (Island Peer Review Organization) when internal payer appeals are exhausted. Applies to medical necessity denials, experimental treatment denials, and out-of-network coverage disputes.
Provider Enrollment Timeline
New York Medicaid provider enrollment through MMIS (Medicaid Management Information System) typically takes 60 to 90 days. Requires application, license verification, background checks, and disclosure statements. Re-validation required every 5 years.
Managed Care Organization Standards
NY Department of Financial Services regulates MCO provider network adequacy, timely access standards, and grievance procedures. Applies to Fidelis, Healthfirst, MetroPlus, and other NY Medicaid MCOs.
9 specialties we bill for New York practices
From cardiology in Manhattan to psychiatry in Brooklyn, our certified coders understand both your specialty and New York payer patterns across the dense NYC metro market and upstate regions.
Cardiology Billing
NY Empire BCBS prior authorization expertise. Fidelis and Healthfirst coordination for cardiac procedures.
Learn more →Orthopedic Billing
NY workers compensation integration with Empire BCBS. Joint replacement expertise for NYC metro market.
Learn more →Psychiatry Billing
NY behavioral health parity plus Healthfirst HARP program expertise. Empire BCBS 90837 documentation templates.
Learn more →Neurology Billing
NY EEG and EMG billing with Empire BCBS prior auth. Fidelis and MetroPlus coverage coordination.
Learn more →Nephrology Billing
NY dialysis billing (90935-90970) with Medicare MSP coordination. Healthfirst and Fidelis CKD expertise.
Learn more →OB/GYN Billing
NY global obstetric packages with Empire maternity bundling. Fidelis and Healthfirst Medicaid enrollment.
Learn more →Endocrinology Billing
NY CGM billing with Empire BCBS prior authorization. Diabetes education codes for Medicaid managed care patients.
Learn more →Podiatry Billing
NY diabetic foot exam billing (LOPS) with NY Medicaid coverage. DME orthotics through Empire and Aetna.
Learn more →Gynecology Billing
NY preventive care coding (Q0091, G0101) with Empire and Fidelis coordination. Colposcopy expertise for NYC market.
Learn more →10 billing services for New York practices
One 4.99 percent flat rate covers the full billing workflow. Every service is tuned for New York payers, New York regulations, and New York practice needs across NYC metro and upstate regions.
Medical Billing
NY 4.99% flat rate with Empire BCBS and Fidelis portal integration. Full-service billing for New York practices.
Learn more →Revenue Cycle Management
NY end-to-end RCM with Healthfirst and MetroPlus MCO handling. 96% clean claim rate for NY practices.
Learn more →Medical Credentialing
MMIS NY Medicaid enrollment plus all New York commercial payers. 60-90 day MMIS timeline.
Learn more →Medical Billing Audit
Free New York billing audit. 90-day AR analysis with NY Prompt Pay Law penalty tracking (12% annual interest).
Learn more →Eligibility Verification
NY real-time payer verification with NY Emergency Services Law surprise billing detection.
Learn more →AR Recovery
NY IPRO external appeal expertise plus written-off claim recovery. Average $180K per audit.
Learn more →Physician Billing
NY solo practitioner support with PECOS Medicare enrollment and Empire BCBS credentialing.
Learn more →Robotic Process Automation
NY auto-claim submission with Fidelis and Healthfirst portal RPA. Same-day claim workflows.
Learn more →Virtual Medical Assistance
NY telehealth billing with POS 02/10 handling. Modifier 95 expertise across commercial and Medicaid plans.
Learn more →Laboratory Billing
NY molecular pathology and CPT 80000-89999. NGS JK LCD-compliant appeals for New York labs.
Learn more →Real New York medical billing results from actual practices
How a Manhattan psychiatry practice recovered $180K from Empire BCBS behavioral health appeals
The Situation
A 4-provider psychiatry practice in Manhattan came to CureMed in Q2 2025 losing significant revenue on behavioral health claims. Empire BCBS was denying 90837 extended therapy sessions at a 28 percent rate, citing insufficient documentation of session length and medical necessity. Their previous billing company was appealing these denials with generic language that Empire kept rejecting. Fidelis Care HARP program claims for severely mentally ill patients were sitting in queue for 60 or more days. Aged AR had grown to $340K.
What We Did
Within the first two weeks, we audited 90 days of aged AR and identified $180K in recoverable revenue tied to Empire BCBS behavioral health denials and Fidelis HARP claims. Deployed our New York-specific behavioral health workflow: Empire BCBS-approved 90837 documentation templates with exact session times and medical necessity language, Fidelis HARP appeals through the DFS complaint process, Healthfirst behavioral health billing for NYC metro Medicaid managed care members, and IPRO external review submissions for exhausted internal appeals.
The Result After 90 Days
The practice added a fifth psychiatrist within the second quarter without hiring additional billing staff. Monthly collections grew 24 percent. Empire BCBS 90837 denial rate dropped from 28 percent to 6 percent. Fidelis HARP claim resolution time dropped from 60 days to 22 days. Three successful IPRO external appeals recovered $47K on previously denied claims.
Practice Manager, 4-provider Psychiatry Group, Manhattan, NY
Common questions about medical billing services in New York
Do you serve small practices in New York or only large ones?
We serve solo practitioners to mid-size groups across New York. This includes single-provider dermatology practices in Manhattan and 20-provider cardiology groups in Buffalo. Our 4.99 percent flat rate applies whether you bill $30,000 or $300,000 per month.
How does CureMed handle the NY Prompt Pay Law?
Every claim we submit is tracked against the New York payment windows under NY Insurance Law Section 3224-a. Electronic claims must be paid within 30 days and paper claims within 45 days. When a payer misses the deadline, we automatically file for the 12 percent annual interest penalty. Most billing companies leave this money on the table. We recover it.
Which New York Medicaid MCOs does CureMed work with?
We work with all major New York Medicaid managed care organizations. This includes Fidelis Care, Healthfirst, MetroPlus Health Plan, EmblemHealth, Empire BlueCross BlueShield Medicaid, MVP Health Care, and Amida Care. Our dedicated New York Medicaid team handles prior authorizations, appeals, and MMIS portal submissions.
How long does provider credentialing take in New York?
Commercial payers: 60 to 90 days on average. New York Medicaid through MMIS: 60 to 90 days. Medicare: 60 to 90 days. We manage the entire application through go-live, and can start billing on day one under a supervising provider while credentialing is in process.
How does CureMed handle IPRO external appeals in New York?
When internal payer appeals are exhausted, we prepare comprehensive external appeal packages for submission to IPRO (Island Peer Review Organization). This applies to medical necessity denials, experimental treatment denials, and out-of-network coverage disputes. Our IPRO specialists compile clinical documentation, prior review history, and regulatory arguments that maximize appeal success rates.
Can you help my New York practice recover aged AR?
Yes. This is one of our specialties. We offer a free 90-day AR audit for New York practices. Our team identifies recoverable claims, files appeals within New York-specific timely windows (which vary by payer between 90 and 180 days), and recovers money that most billing companies wrote off. Average recovery in our first New York AR audits ranges from $150,000 to $280,000 per practice.
Get a free medical billing audit for your New York practice
We will review 90 days of claims and show you exactly where revenue is slipping. No obligation, no sales script. Just real numbers for your New York practice.