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Medonix

Northeast · NY · Empire State

Medical billing services in New York.

New York runs the strictest prompt-pay statute in the U.S. (45 days for clean claims with 12% interest after) and OMIG maintains aggressive audit posture across primary care, DME, and behavioral health. Healthfirst dominates Medicaid managed care, and the state's Excelsior Plan options affect commercial billing for state employees. Medonix delivers AI-native billing and RCM into New York with state-specific payer expertise and engagement-specific service-level targets aligned to MGMA top-performer benchmarks, written into your contract.

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95%+Clean-claim target (MGMA)
<30dA/R target (HFMA)
47%NY Medicare Advantage
5%NY uninsured rate

The New York billing landscape

New York medical billing has its own rules.

Medical billing in New York is not the same as billing in the state next door. The New York Medicaid program runs on its own fee schedule and prior-auth rules. New York commercial plans negotiate local network contracts that affect allowed amounts and patient liability. The New York insurance department enforces prompt-pay statutes with specific timelines and penalties. State-specific telehealth parity, scope-of-practice, and No Surprises Act enforcement all change the calculus.

Medonix runs a New York-specific layer on top of the national payer-rule engine. In New York we routinely bill Empire BlueCross BlueShield, UnitedHealthcare, Aetna, Cigna, Fidelis Care, Healthfirst, plus Medicare, NY Medicaid Managed Care, and the major commercial carriers. Each payer is handled with payer-specific scrub rules so denials get caught at the clearinghouse rather than at the EOB.

New York serves roughly 19.5M residents (the "Empire State"), and the volume reality means even a one-percentage-point lift in clean-claim rate translates to material cash recovery for groups operating across multiple NY sites.

If you operate across New York and other U.S. states (telehealth, multi-state groups, MSOs), the playbook stays the same. The state-specific rule layer changes per state. One contract, one dashboard, state-by-state reporting under the hood.

Payer landscape

Top New York payers we bill every day.

  • Empire BlueCross BlueShield
  • UnitedHealthcare
  • Aetna
  • Cigna
  • Fidelis Care
  • Healthfirst
  • Medicare
  • NY Medicaid Managed Care
  • TRICARE

NY Medicaid Managed Care

Managed-Medicaid plans operating in New York.

Each MCO carries its own prior-auth list, claim-edit rules, and encounter submission cadence. Medonix runs plan-specific scrub logic per carrier:

  • Healthfirst
  • Fidelis Care
  • MetroPlus
  • EmblemHealth Enhanced Care
  • Anthem HealthPlus
  • Affinity Health Plan
  • MVP Health Care

New York expanded Medicaid under the ACA, keeping the uninsured rate around 5%.

Specialty mix

Specialties over-represented in New York.

Specialty playbooks tuned to the New York case mix and payer behavior:

  • Cardiology
  • Oncology
  • Orthopedic surgery
  • Plastic surgery
  • Psychiatry

Statewide systems

New York health systems Medonix coordinates with.

  • NewYork-Presbyterian
  • Mount Sinai Health System
  • NYU Langone
  • Northwell Health
  • Montefiore

Regulatory context

New York regulatory compliance.

NY Insurance Law §3224-a (prompt pay) and §3217-b (network adequacy) impose strict timelines on payer responses, with 12% interest accruing on unpaid clean claims after 45 days.

Cities we serve in New York

Medonix delivers medical billing across New York with local payer-mix knowledge in each metro area. Click any city for the local engagement detail.

Specialties served

Specialty-engineered playbooks for every discipline.

Each specialty gets its own CPT/ICD logic, payer edits, and dedicated credentialed coding team. Drag to explore.

Drag · scroll · 35 specialties

Frequently asked

Medical billing in New York, answered.

The questions New York practice owners and CFOs ask before they switch billing. Book a 30-minute call if yours is not here.

Yes. Medonix delivers medical billing and revenue cycle management to New York healthcare providers across the state, with operators familiar with NY payer mix, NY Medicaid Managed Care plan logic, and the regulatory specifics that govern billing here. New York's 19.5M residents are served from solo practices through enterprise hospital systems.

Data sources & methodology

Statistics on this page reference KFF State Health Facts (Medicaid expansion, uninsured rate), CMS Monthly Enrollment Report (Medicare Advantage penetration), U.S. Census Bureau (population), and NY Department of Insurance filings (prompt-pay statutes, MCO rosters).

Service-level targets referenced on this page (95%+ first-pass clean-claim rate, sub-30-day A/R) are the MGMA top-performer and HFMA best-in-class benchmarks. Engagement-specific targets are agreed in writing for each NY client. Last reviewed: May 2026.

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