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New York runs Medicaid claims through eMedNY, funnels most enrollees into one of about a dozen managed care plans, and holds every commercial insurer to a 30- or 45-day payment clock under state law. A2Z Billings builds around all three, remotely, for practices across the state.
That's the interest rate Insurance Law § 3224-a puts on any claim an insurer pays late, past 30 days for an electronic submission or 45 for paper. Most practices never invoice for it.
Where a practice sits changes which plans it deals with and how many. New York City and Long Island look nothing like the rest of the state.
Where the MCOs concentrate. Nearly every Medicaid managed care plan in the state writes business here, including Fidelis Care, Healthfirst, MetroPlus, and Amida Care. A downstate practice can carry ten or more MCO contracts at once, each on its own credentialing calendar.
Fewer plans, wider territory. A smaller set of plans covers upstate counties, among them Molina Healthcare of New York and Excellus BlueCross BlueShield, each serving a much larger geographic area. Fewer contracts sounds simpler, but one denial touches a bigger share of the patient list.
Where it still exists. A narrow slice of New York Medicaid, mostly certain long-term care and specialty services, is still paid directly through eMedNY instead of through a managed care plan. It's a small share of the program, and it runs on its own forms and timelines.
Where most of it runs today. Most Medicaid enrollees are assigned to one of roughly a dozen managed care plans. Each one credentials providers separately, sets its own utilization review rules, and processes claims on its own system, apart from eMedNY.
Five issues account for most of the delays we see in New York practices. Here's what causes each one.
A practice treating an auto accident patient sometimes applies its usual commercial timeline instead of No-Fault's, and misses the 45-day NF-3 deadline or the separate 90-day window for lost-wage claims.
The 28-day window that protects an inpatient SUD admission from utilization review only applies if the facility notifies the insurer of the admission and treatment plan within 48 hours. Miss that call and the protection doesn't apply.
Ten or more MCO contracts, each on its own re-credentialing cycle separate from state PSP enrollment, and one lapsed plan can quietly stop paying for months before anyone notices.
The Workers' Compensation Board pays off its own fee schedule and uses its own authorization forms, like the MG-2 for a treatment variance request, not a standard payer's prior-auth process.
New York's own dispute resolution process for certain out-of-network and emergency bills predates the federal No Surprises Act, and a claim sent through the wrong one can sit for months.
30/45-day Prompt Pay clock · 12% late interestNo generic process. Each problem above gets its own ongoing check, not a one-time fix.
The same functions any billing partner offers, adjusted for eMedNY, MCO edits, No-Fault, and Workers' Comp, not a generic national default.
Filed to eMedNY, the correct Medicaid MCO, the No-Fault insurer, or the Workers' Comp Board, each on its own timeline.
Coding matched to OASAS behavioral health rules, No-Fault's NF-3 requirements, and each MCO's own edits.
Every downstate or upstate MCO contract tracked on its own calendar, alongside state PSP enrollment.
Charge capture and denial resolution run across departments, whether a practice bills one payer type or five.
Checked at every visit, since MCO enrollment, No-Fault status, or a comp claim can change between appointments.
Requests filed only where actually required, skipping OASAS-exempt admissions and following each MCO's own review rules.
The specific MCO, No-Fault, or comp denial code pulled, and the root cause fixed before resubmission.
Remittances checked against the 30- or 45-day Prompt Pay clock and against No-Fault's separate 30-day pay-or-deny rule.
Aged claims worked against whichever payer's actual deadline applies, not one default clock for everything.
Payer rules and referral patterns shift by specialty. Here's where we already have New York-specific billing experience built in.
OASAS-certified admissions skip preauthorization entirely and get a 28-day window before utilization review starts, as long as the facility notifies the insurer within 48 hours of admission.
A large share of these referrals trace back to auto accidents or workplace injuries, which means billing No-Fault or the Workers' Comp Board instead of a standard commercial plan.
Advanced imaging and device procedures draw heavy prior-authorization scrutiny, and bundling errors between the imaging and the procedure are a recurring cause of denials.
Most directly affected by Medicaid's managed care structure, since a plan change updates referral rules for every specialist a patient sees downstream.
Coding depends on correctly identifying facility type, since the applicable fee schedule differs by whether a visit is billed as urgent care or emergency department.
Visit caps and re-authorization thresholds differ by payer, and No-Fault claims for accident-related therapy follow the 45-day NF-3 clock instead of a standard commercial deadline.
We also support gastroenterology, dermatology, radiology, neurology, and general surgery practices.
The stages are the same ones used everywhere. What changes here is what has to happen inside each one.
Captures the right payer type up front: Medicaid MCO, commercial, No-Fault, or workers' comp.
Checked same-day, not only at intake, since MCO and comp claim status can shift.
Catches OASAS, No-Fault, and MCO-specific coding requirements before submission.
Routed to eMedNY, the correct MCO, the No-Fault carrier, or the Workers' Comp Board.
Flags any claim paid past its actual deadline, whether that's the 30/45-day Prompt Pay clock or No-Fault's 30-day rule.
Pulls the specific payer denial code instead of guessing at the cause.
Filed within each payer's own window, including New York's own dispute resolution process where it applies.
Worked on a cadence matched to each payer type's actual timeline.
Shows clean claim rate, days in AR, and denial trends broken out by payer, so a weak spot doesn't hide inside a blended average.
Building the knowledge to bill eMedNY, a dozen MCO systems, No-Fault, and Workers' Comp correctly takes most in-house hires a year or more, and it walks out the door the day they leave. A remote team spreads that knowledge across more people, so one departure doesn't stall a practice's claims.
No. Our team works remotely and coordinates directly with your front desk on intake, authorization, and payer-specific requirements.
Each plan runs its own credentialing cycle, separate from state PSP enrollment. We track every open application on one calendar so nothing lapses unnoticed.
A late NF-3 can be denied outright, which is why we track the treatment date, not the billing date, against that deadline for every accident-related patient.
We file the 48-hour admission and treatment plan notice that triggers the 28-day utilization-review-free window, so the facility gets the protection the law actually provides.
Yes, including the Board's own fee schedule and authorization forms, which run separately from a standard commercial prior-authorization process.
It predates the federal No Surprises Act and applies to a narrower set of claims, so we check which process actually governs a given bill before filing a dispute.
See exactly where your practice is losing time and revenue to New York's payer rules, and what changes once a team that already knows them takes over.
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