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Medical Billing Services for New York Healthcare Practices

New York billing runs on more rules than most states. Medicaid claims move through eMedNY or a managed care plan, Workers' Compensation bills go through a Board-approved electronic partner, auto injuries fall under No-Fault and commercial claims carry their own filing windows. When one of those workflows breaks, it shows up weeks later as denials and aging A/R.

Dastify Solutions manages medical billing for New York practices from eligibility through payment. Our credentialed coders and billers are assigned by specialty and every workflow is built around your payer mix, provider structure and existing EHR.

Your audit shows where claims are being rejected, denied, underpaid, or left in aging A/R and which fixes will have the most impact.

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  • 99% Client retention
  • 50+ Specialties supported
  • BBB Accredited
  • HIPAA Compliant

New York Billing Rules We Build Into Your Workflow

The right process depends on the payer, coverage type, provider type, claim format and date of service. We map these differences during onboarding and update your billing controls when official guidance changes.

New York Medicaid and eMedNY

Medicaid fee-for-service claims follow eMedNY provider manuals and transaction specifications. We submit through the correct professional or institutional pathway, confirm enrollment data and work every rejected, pended, or denied claim from the remittance. Medicaid managed care claims follow each plan's own rules. Under New York's prompt pay law, providers must submit claims within 90 days of service for Medicaid managed care plans and within 120 days for other regulated health plans, unless the contract allows more time (NY DFS). We track these filing windows claim by claim.

Surprise Bills and Out-of-Network Claims

Which rules apply depends on the patient's coverage. New York's surprise bill law governs most fully insured state-regulated plans, while the federal No Surprises Act covers self-funded employer plans and other federally protected situations (NY DFS Surprise Medical Bills). We identify the plan type on each out-of-network claim, apply the right notice and cost-sharing path and flag claims that may qualify for independent dispute resolution. Legal strategy for disputed claims stays with your counsel.

New York Workers' Compensation

Since August 1, 2025, every provider treating Workers' Compensation patients in New York must submit the CMS-1500 electronically through a Board-approved submission partner. The rule applies to each individual provider in a practice (NY Workers' Compensation Board). We manage the submission route, required narrative, provider authorization status and payer follow-up.

New York No-Fault Auto Claims

Treatment for auto accident injuries is billed to the No-Fault carrier, generally on the NF-3 form. Under Regulation 68, providers must submit bills within 45 days of service (NY DFS No-Fault FAQ). We track that deadline, respond to verification requests and follow up on delayed or denied bills.

SPARCS Reporting for Hospitals and Facilities

SPARCS is New York's all-payer data system for hospital inpatient stays and specified outpatient services, such as ambulatory surgery and emergency department visits (NYSDOH SPARCS). It does not apply to routine physician office claims. For hospitals and ambulatory surgery centers, we keep billing data consistent with SPARCS submissions.

HIPAA and Your Business Associate Agreement

Billing and claims processing are business associate functions under HIPAA (HHS). Dastify Solutions signs a business associate agreement with every client and documents how we control access, safeguard data, manage subcontractors, report incidents and return or destroy data when an engagement ends.

Medical Billing Services Across the Revenue Cycle

Front-desk errors turn into denials weeks later. We connect each stage to the next, so missing information is caught early and every unpaid claim has a documented owner.

Eligibility and Benefits Verification

We verify active coverage, copays, deductibles, benefit limits and authorization requirements before the visit and flag exceptions for your staff. Your team gets a clear basis for patient estimates and fewer rejections from inactive or incomplete coverage.

Prior Authorization Tracking

We track each request, reference number, approved service, date range and unit limit, and flag any mismatch between the authorization and the scheduled or billed service before the claim goes out.

Medical Coding and Charge Review

Specialty-assigned coders review ICD-10-CM, CPT, HCPCS, modifiers, place of service, and NCCI edits. When documentation is incomplete or code selection is unclear, we send a query to the provider instead of guessing.

Claim Scrubbing and Submission

We check demographics, provider identifiers, code pairs, modifiers, units and payer formatting before submission, then route claims through the correct clearinghouse or payer channel. Rejections are corrected and resubmitted denials go to our appeals workflow.

Payment Posting and Underpayment Review

We post electronic and paper remittances, apply adjustments and reconcile deposits. CARC and RARC codes drive follow-up and payments below the contracted rate are documented and appealed where the contract supports it.

Denial Management and Appeals

We group denials by payer, reason, provider and service to separate one-off errors from recurring workflow failures. We correct and resubmit or appeal actionable claims, then report the root cause so it does not repeat.

Accounts Receivable Follow-Up

We prioritize unpaid claims by age, value, payer and filing deadline. Every follow-up note records the payer contact, claim status, reference number and next action, which turns your aging report into a working queue.

Patient Billing Support

We prepare clear patient statements that reflect posted payer activity and handle routine balance questions. Financial assistance and collection policies stay with your practice.

Credentialing and Payer Enrollment

We handle CAQH, NPI, Medicare, Medicaid and commercial payer enrollment so new providers can start billing as soon as enrollment is approved.

New York Payers We Work With

Our team works daily with the payers that make up most New York payer mixes, including:

Medicare

New York Medicaid (eMedNY) and Medicaid managed care plans

Fidelis Care

Healthfirst

Emblem Health

Empire BlueCross BlueShield

UnitedHealthcare

Aetna

Workers' Compensation and No-Fault carriers

How Onboarding Works

A clean transition starts with ownership and data not a software promise. Here is how we take over billing without losing claims in the handoff.

01.

Baseline billing review.

We review your A/R aging, denial reasons, rejection reports, payer mix and open work queues to set a starting point.

02.

Scope and access.

Together we document included services, system and portal access, approval points, escalation contacts and reporting cadence.

03.

Claim handoff.

Open claims are assigned by date of service, payer and status so nothing is worked twice or missed. If your current biller stays on during the transition, we set a written cutoff date.

04.

Ongoing review.

Regular reviews cover new claim denials, underpayments and aging A/R. Repeat problems become corrective actions with an owner and a due date.

Why New York Practices Choose Dastify Solutions

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Transparent pricing.

Full-service medical billing Starts at 2.99% of monthly collections, with no long-term contract.

Specialty-assigned team.

Credentialed coders and billers matched to your specialty with a dedicated account manager as your single point of contact.

Compliance oversight.

The New York billing guidance on this page is reviewed by our Director of Compliance.

You keep your systems.

We work inside your existing EHR or practice management system including: Epic, Athena, AdvanceMD, CureMD, Tebra and simple pratice.

Reporting you can act on.

Monthly reports tie every metric to a cause and an owner.

Specialties We Support in New York

We support small practices, physician groups, specialty clinics, ambulatory providers, and facilities. Specialties we support include:

General Surgery
Cardiology
OB/GYN
Dermatology
Physical Therapy
Family Practice
Home Health
Radiology
Pediatrics
Urgent Care

For every specialty, onboarding answers four questions:

  • Which services, code families and modifiers drive your claim volume?
  • Which payers and authorization rules cause the most rework?
  • Which documentation or charge-capture gaps delay submission?
  • Which denial and A/R categories should be fixed first?
View all specialties

Reporting That Shows Where Claims Stall

Every report defines its data source, calculation and period so the numbers can be checked. Core measures include:

Clean Claim Rate

claims accepted on first submission without correction.

Denial Rate

adjudicated claims denied by the payer with the denominator stated.

Days in A/R

average age of outstanding receivables by payer and aging bucket.

Net Collection Rate

payments collected against contractually collectible charges.

Underpayment Variance

the gap between payments received and contracted rates.

Appeal inventory

open appeals by payer, age, value and next action.

No single number proves billing performance, so we review these measures together against your starting baseline.

Clinician holding a binder to her head at her desk

Also available: Credentialing and payer enrollment for new providers and locations.

Billing rules vary by payer, provider type, contract, coverage, and date of service, and may change. This page is general information, not legal or coding advice. Confirm current requirements with the payer or agency.

Frequently Asked Questions

What do your New York medical billing services include?

Eligibility and benefits verification, prior authorization tracking, coding review, claim scrubbing and submission, payment posting, denial management and appeals, A/R follow-up, patient billing support, credentialing and reporting. Your agreement lists exactly which services we handle and which stay with your practice.

How do you handle New York payer-specific rules?

We build claim and follow-up workflows around your payer mix, provider type, specialty, and claim format, using current CMS, eMedNY, New York agency and payer guidance. We monitor updates and adjust your workflows when requirements change.

Do you handle Workers' Compensation and No-Fault claims?

Yes. We manage electronic CMS-1500 submission through a Board-approved partner for Workers' Compensation and NF-3 billing within the 45-day window for No-Fault.

Does every New York practice need SPARCS reporting?

No. SPARCS applies to hospital inpatient stays and specified outpatient services such as ambulatory surgery and emergency visits. Most physician offices do not report to SPARCS.

How much do your medical billing services cost?

Full-service billing starts at 2.99% of monthly collections with no long-term contract. Your quote depends on specialty, volume, scope and we confirm it after the free audit.

Can you guarantee payment or eliminate denials?

No billing company can honestly guarantee payment. Payment depends on coverage, authorization, medical necessity, documentation, coding and payer decisions. What we do is catch preventable errors before submission, work every denial, and show you exactly where revenue is stuck.

Can you work with our current EHR or practice management system?

Yes. We work inside your existing system, so your clinical workflow stays the same. We confirm access, clearinghouse routing, and data export during onboarding.

What should we check before outsourcing medical billing?

Confirm the service scope, fees, contract term and exit rights, business associate agreement, security controls, staff qualifications, reporting definitions, and how your data is returned if you leave. Ask whether Workers' Compensation, No-Fault, out-of-network claims, and credentialing are included.

What does the free billing audit include?

We review a sample of your recent claims, denials and A/R aging then show you where claims are rejected, denied, underpaid, or stalled with prioritized fixes. There is no obligation to sign up.

Start With a Free Billing Audit

If rejected claims, repeat denials, underpayments or aging A/R are pulling your staff away from patients, start with a review of your current billing data. We will show you where revenue is stuck and which billing functions make sense to outsource.

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Written by Ricky Bell
Reviewed by Anum Naveed Director of Compliance
Last updated