Medical Billing Services in New York

One Team Accountable for the Whole Cycle

Most revenue loss starts before a claim is filed and continues after it is paid. A wrong plan on a registration form turns into a denial weeks later. A missing modifier becomes an underpayment no one reviews. When billing, coding, and collections sit with different vendors, each problem gets handed along instead of fixed.

QWay manages every stage, so errors are corrected where they begin:

• Front end: Eligibility and benefits verification, registration checks, and prior authorization before the visit.
• Coding: ICD-10-CM, CPT, HCPCS, and modifier assignment by certified coders, with provider queries when documentation falls short.
• Claims: Charge entry, payer-specific claim scrubbing, and electronic submission.
• Payments: Payment posting, reconciliation, and underpayment review.
• Denials and A/R: Root-cause analysis, corrected claims, appeals, aging follow-up, and old-balance cleanup.
• Patient billing: Statements and balance follow-up.
• Credentialing: Enrollment, recredentialing, and revalidation.
• Reporting and connectivity: Performance reporting and support for EHR, practice-management, and clearinghouse workflows.

Take the full cycle or start with one stage and add more later.

Where New York Providers Lose Revenue

Medicaid managed care plans each set their own rules

New York Medicaid pays through fee-for-service and through managed care plans such as Healthfirst, MetroPlus, Fidelis Care, and EmblemHealth. Each plan has its own authorization requirements and appeal windows. Fee-for-service claims go through eMedNY, while managed care claims follow plan-specific workflows. We confirm which coverage applies before the visit, apply separate claim checks per plan, and work denials through each plan's own process.

OMIG audits can reach back to paid claims

The Office of the Medicaid Inspector General audits Medicaid billing and can seek repayment on claims already paid. Unsupported documentation is the usual cause. Our coders compare notes to billed services before claims go out, and gaps go back to the provider while the visit is recent.

No-fault claims run on short deadlines

No-fault pays first on auto injury claims, and bills must reach the carrier within 45 days of the date of service. Verification requests arrive with their own response windows. A late bill can mean no payment. We monitor each claim's timeline from the first visit, support fee-schedule review, respond to carrier requests, and escalate unpaid claims.

Workers' compensation follows a separate rulebook

Workers' compensation claims use state fee schedules, treatment guidelines, and authorization requirements that differ from commercial billing. Care delivered without approval is often denied. We verify authorization status, direct claims to the right carrier or administrator, and follow up by aging bucket.

Medicare and Medicare Advantage split the same patient base

Original Medicare Part B claims from New York go to National Government Services, the contractor for Jurisdiction K. Medicare Advantage plans apply their own referral and authorization rules. Misidentified coverage at registration sends claims to the wrong payer. We confirm plan type at scheduling and check each claim against the correct requirements.

Downstate and upstate payers differ

Empire BlueCross BlueShield, a downstate carrier, runs its own authorization and appeal process. Providers in Buffalo, Rochester, Albany, and Syracuse bill Excellus, CDPHP, MVP, and Independent Health instead. A team trained on one market struggles in the other. We maintain payer-specific workflows for both.

Out-of-network billing carries its own rules

New York and federal law protect patients from certain surprise bills, including emergency care and some out-of-network services at in-network facilities, and both set dispute processes for payment disagreements. We review claims against patient benefits, flag payment variances, and manage follow-up. Consult legal or compliance counsel on your specific obligations.

Providers We Support Across New York

We work with practices and facilities in New York City, Long Island, Westchester, Albany, Buffalo, Rochester, Syracuse, and communities across the state.

• Independent practices and medical groups: less claim rework, consistent coding across providers, and clear denial patterns by site
• Orthopedic, pain management, physical therapy, and chiropractic practices: deadline monitoring, authorization tracking, and documentation review for heavy no-fault and workers' compensation volume
• Hospitals and health systems: high-value accounts worked first, with underpayments and payer delays escalated
• Behavioral health providers: monitoring of authorized visit limits and time-based coding
• Urgent care centers and ambulatory surgery centers: eligibility and authorization checks ahead of service, then fast follow-up on rejected claims

Start With a Review of Your Revenue Cycle

Tell us your specialty, payer mix, and where claims are stuck. We will go through your denial and A/R picture and show you what we would change first.

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