New York Billing Reference

Medical Billing in New York: Payer Landscape, Medicaid & Timely Filing

New York Medicaid is the second largest in the US by total spending. Managed Long-Term Care (MLTC) and Health and Recovery Plans (HARP for behavioral health) layer complexity beyond standard managed care. Commercial payers are highly fragmented — BCBS, EmblemHealth, MVP, and dozens of regional plans. Medicaid timely filing is 90 days, among the shortest in the country.

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Medical Billing in New York: The Short Version

New York combines the strictest Medicaid timely-filing window of any large state (90 days through eMedNY) with a payer landscape unlike anywhere else: regional nonprofits like Healthfirst and EmblemHealth compete with Empire BCBS and national carriers, and New York's surprise-billing law predates and exceeds the federal No Surprises Act. Labor costs make billing errors more expensive to rework in NY than in any other market.

Payer Landscape

Major Payers in New York

Payer	Type	What Billing Teams Should Know
Empire BCBS (Anthem)	Commercial / Blue plan	Largest commercial payer downstate; Anthem systems and policies
UnitedHealthcare / Oxford	Commercial	Oxford products have distinct referral and network rules from UHC national
EmblemHealth (GHI/HIP)	Regional commercial	Legacy GHI and HIP lines still carry different rules under one brand
Healthfirst	Regional nonprofit	Medicaid, MA, and commercial exchange products; NYC-centric
Aetna	Commercial / MA	Large employer book in metro NY
Cigna	Commercial	Employer self-funded concentration
NY Medicaid (eMedNY)	Medicaid	90-day filing — the strictest of any large state

Medicaid Structure

New York Medicaid: Managed Care Plans

Administered by the NY Department of Health, claims through eMedNY. The patient's plan assignment — not just Medicaid eligibility — determines the portal, prior-auth list, and filing rules that apply.

Plan	Notes
Fidelis Care (Centene)	Largest Medicaid managed care plan statewide
Healthfirst	Provider-sponsored nonprofit; dominant in NYC boroughs
MetroPlusHealth	NYC Health + Hospitals plan; NYC-focused
UnitedHealthcare Community Plan	Statewide managed Medicaid presence
Molina Healthcare of New York	Formerly Affinity; NYC metro
Anthem HealthPlus (Empire)	Empire’s managed Medicaid line

Filing Deadlines

Timely Filing Limits for New York Claims

Initial-claim windows for the payers New York practices bill most. Commercial limits are contract-specific — always confirm against your provider agreement and the payer's current manual.

Payer	Timely Filing Limit	Notes
New York Medicaid (eMedNY)	90 days from date of service	Delayed-claim submission requires documented exception reason codes
Medicare (original)	12 months from date of service	Set by federal law; no contract variation
UnitedHealthcare (commercial)	90 days from date of service	Contract-specific; some plans allow 180
Aetna (commercial)	120 days from date of service	Contract-specific; verify provider agreement
Cigna (commercial)	90 days from date of service	Contract-specific; verify provider agreement
Humana (commercial)	90 days from date of service	Among the strictest; Medicare Advantage differs

Verified against payer publications at time of writing (July 2026). Filing limits change by contract and plan year — treat this table as a starting point, not a substitute for the payer manual. See our methodology.

NY-Specific Rules

New York Billing Realities to Know

90-Day Medicaid Window

eMedNY’s 90-day limit means Medicaid claims must go out clean the first time. Exception codes exist for late claims but are narrowly applied.

Surprise Billing Rules

NY’s surprise billing law (2015) predates the federal No Surprises Act and includes an independent dispute resolution process; both regimes can apply depending on plan type.

Oxford Is Not UHC

Oxford plans under the UnitedHealthcare umbrella retain separate referral requirements, networks, and policies. Treating them as generic UHC causes referral-related denials.

High-Cost Rework Market

NYC billing labor costs make each denied claim disproportionately expensive to work — prevention economics are stronger in NY than anywhere else.

Frequently Asked Questions

New York Medicaid allows 90 days from date of service for initial claims, administered by the NY Department of Health, claims through eMedNY. Managed care plans operating in New York may apply shorter contractual windows, so always verify each plan's provider manual.

Fidelis Care (Centene), Healthfirst, MetroPlusHealth, UnitedHealthcare Community Plan, Molina Healthcare of New York, Anthem HealthPlus (Empire). Each plan maintains its own provider portal, prior authorization list, and claim submission rules — the patient's plan assignment, not just Medicaid status, determines how a claim must be billed.

Empire BCBS (Anthem), UnitedHealthcare / Oxford, EmblemHealth (GHI/HIP), Healthfirst, Aetna, alongside Medicare and New York Medicaid. See the payer landscape table on this page for what billing teams should know about each.

New York’s 2015 surprise billing law covers state-regulated plans, with its own independent dispute resolution process; the federal No Surprises Act covers self-funded ERISA plans. Which regime applies depends on the plan’s funding type — billing teams need to identify plan funding before deciding the dispute pathway.

Code Reference

Common Codes Billed in This State

Frequently billed codes in this state’s payer environment, with notes on state-specific rules and common denial patterns.

Code	Description	State-Specific Note
99213	Office visit, est. patient — level 3	Medicaid managed care MCO determines rate; verify plan
99214	Office visit, est. patient — level 4	EmblemHealth and BCBSNY have distinct auth workflows
T2025	Specialized supportive living services	Common under MLTC (Managed Long-Term Care) plans in NYC
H0031	Mental health assessment — by non-physician	HARP (Health and Recovery Plan) has separate billing rules
Mod. GT	Telehealth — real-time audio/video	NY Medicaid 90-day filing window is strict; file quickly
CO-16	Claim lacks required information	Most common denial in NYC Medicaid; often missing plan-specific NPI

Codes and reimbursement rates change annually. Verify current fee schedules with each payer before billing. Full code lookup →