MedStats Billing delivers end-to-end revenue cycle management built for New York practices. We work the strictest no-fault deadlines in the country under Regulation 68, enforce the 30-day electronic prompt pay standard in Insurance Law § 3224-a, and handle workers’ compensation billing under the Board’s mandatory electronic CMS-1500 rules across the Empire State.
New York imposes shorter filing deadlines and harsher consequences for missing them than any other state MedStats serves. A no-fault bill filed on day 46 is presumptively denied. A workers’ compensation bill submitted on paper can now be rejected outright, with the Board declining to enforce payment. And prescription drugs, behavioral health and family planning each follow a different route through Medicaid than the rest of a patient’s care. Deadline discipline is not a nice-to-have in New York — it is the whole job.
New York Billing Specializations:
No-Fault Regulation 68 (11 NYCRR Part 65) — The NF-2 application must reach the carrier within 30 days of the accident and provider bills on Form NF-3 within 45 days of the date of service. We file inside both windows and prepare reasonable-justification documentation when a late bill is unavoidable.
New York Prompt Pay (Insurance Law § 3224-a) — Undisputed claims must be paid within 30 days if transmitted electronically or 45 days on paper. Overdue claims carry interest at the greater of 12% per annum or the corporate tax rate. We track every claim against the correct clock.
Mandatory Electronic CMS-1500 for Workers’ Compensation — Since August 1, 2025 a payer may deny a paper CMS-1500 outright and the Board will not enforce payment. Denied bills must be resubmitted electronically through an approved partner within 120 days of the date of service.
The 45-Day Objection Rule (12 NYCRR 325-1.25) — If a carrier fails to object within 45 days of acknowledging a bill, it is liable for the full amount billed up to the fee schedule maximum and the Board will not review a later objection. We track acknowledgement dates and pursue that liability.
NYRx and Medicaid Carve-Outs — Retail pharmacy is carved out to NYRx for mainstream managed care, HARP and HIV-SNP members, behavioral health is carved in, and family planning stays fee-for-service regardless of enrollment. Each route is billed to a different entity.
Major New York Payers — Fidelis Care, Healthfirst, MetroPlusHealth, EmblemHealth, Excellus BlueCross BlueShield, MVP Health Care, CDPHP, Independent Health, Anthem and Oxford denial workflows.
Built to bring clarity, control and consistency to your New York practice’s revenue cycle.
MedStats Billing manages the complete revenue cycle for New York providers — from eMedNY and commercial enrollment, through no-fault and workers’ compensation filing inside statutory windows, to arbitration support and recovery of aged receivables.
Certified CPT, ICD-10-CM, and HCPCS coding with pre-submission claim scrubbing built around each payer's edits, so claims pay on the first pass. We manage charge entry, claim submission, payment posting, and insurance follow-up.
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Enrollment with Medicaid managed care plans, Medicare via PECOS, and commercial payers — plus CAQH maintenance and re-credentialing deadline tracking, so your providers stay in-network and billable without gaps.
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Coverage confirmed before the visit — active policy status, deductibles, co-pays, plan type, and prior authorization requirements — so front-end denials are caught while there is still time to fix them.
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Aged claims worked by payer and denial reason, with appeals filed inside each plan's window. We monitor outstanding balances, manage rejections, and drive down days in A/R to protect cash flow.
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A detailed review of coding accuracy, documentation standards, and denial patterns that identifies revenue leakage and compliance exposure — before a payer audit finds it for you.
Explore serviceLocal SEO, Google Business Profile optimization, and reputation management built for medical practices — helping the patients already searching for your specialty find you first.
Explore serviceNew York practices lose revenue to deadlines rather than to coding. Four windows close quietly, and once they do the money is unrecoverable. These are the four we protect:
Provider bills must reach the no-fault carrier on Form NF-3 within 45 days of the date of service. Late bills are routinely denied, and courts enforce the 30-day NF-2 notice requirement as a strict condition of coverage without the carrier having to show any prejudice.
Since August 1, 2025 a payer receiving a paper CMS-1500 may deny it and the Board will not enforce payment. The bill must be resubmitted electronically through an approved partner within 120 days of the date of service or it is lost.
Under 12 NYCRR 325-1.25 a carrier that does not object within 45 days of acknowledging a bill is liable for the full amount billed up to the fee schedule maximum. Practices that never track acknowledgement dates hand that liability back to the payer for free.
Retail pharmacy runs through NYRx, behavioral health through the mainstream plan or a HARP, and family planning stays fee-for-service. Claims sent to the plan instead of the correct entity are denied on a technicality that never appears in the clinical record.
Insurers and HMOs must pay undisputed claims within 30 days when transmitted electronically, or 45 days on paper or fax. A payer that requests medical-necessity documentation more than 30 days after receiving a bill violates the statute if payment is not made within 45 days.
Overdue claims carry interest at the greater of 12% per annum or the corporate tax rate set under Tax Law § 1096, computed from the date payment was due. We calculate what is owed and pursue it rather than accepting the principal alone.
NF-2 within 30 days of the accident, NF-3 bills within 45 days of service, and the carrier must pay or deny within 30 calendar days of proof of claim. Verification requests are due within 15 business days. Where an assignment is accepted and the carrier denies, we pursue AAA arbitration rather than billing the patient.
Electronic CMS-1500 submission is mandatory; paper bills can be denied outright. Payers must pay in full or file objections on Form C-8.1B or C-8.4 within 45 days of acknowledgement, and we file Form HP-1.0 through OnBoard when they do neither.
MedStats Billing provides tailored billing solutions for a wide range of medical specialties, ensuring accurate coding, fewer denials, and faster reimbursementsto maximizes your revenue potential.
MedStats Billing handles eMedNY enrollment, commercial credentialing, no-fault and workers’ compensation filing inside statutory windows, prompt-pay enforcement and arbitration support across New York, giving practices end-to-end RCM discipline in the least forgiving billing environment in the country.
Every claim is tracked against the specific statutory window that governs it — 30 days, 45 days or 120 days — because in New York the deadline decides whether the claim is payable at all.
Rejected claims are audited immediately, appealed with complete clinical documentation, and escalated to arbitration or the Board when a carrier will not resolve them.
Monthly reporting on collections, AR aging and denial trends keeps you fully informed on the health of your revenue cycle.
Working knowledge of Fidelis Care, Healthfirst, MetroPlusHealth, EmblemHealth, Excellus BlueCross BlueShield, MVP, CDPHP and Oxford submission protocols.
Whether you practice in Manhattan, Brooklyn, Buffalo or the Hudson Valley, our workflows adjust seamlessly as your group grows.
HIPAA-compliant data handling and controlled access protect patient health information and billing records at every stage.
We integrate smoothly with widely used EHR platforms to ensure accurate data flow from documentation to claim submission. This reduces manual errors, speeds processing, and supports cleaner reimbursements.
We work alongside leading systems including:
Schedule a complimentary billing assessment with MedStats Billing to uncover hidden revenue loss, confirm your no-fault and workers’ compensation filings are landing inside their statutory windows, and recover unobjected bills the Board can still award in your favour.
Under Insurance Law § 3224-a, insurers and HMOs must pay undisputed claims within 30 days if the claim is transmitted electronically, or 45 days if submitted on paper or by fax. Overdue claims carry interest at the greater of 12% per annum or the corporate tax rate, computed from the date payment was due.
Under Regulation 68, the NF-2 application must reach the carrier within 30 days of the accident and provider bills on Form NF-3 within 45 days of the date of service. Lost wage claims are due within 90 days. The carrier must then pay or deny within 30 calendar days of receiving proof of claim.
Once a provider accepts an assignment of benefits and the carrier denies the claim as not medically necessary or unrelated to the accident, the provider must resolve it through no-fault arbitration or in court. Under the terms of the assignment the provider may not bill the patient instead.
Yes. Since August 1, 2025 a payer may deny a CMS-1500 that was not submitted through a Board-approved electronic submission partner, and the Board will not enforce payment. Denied bills must be resubmitted electronically within 120 days from the date the care was rendered.
Under 12 NYCRR 325-1.25, a carrier that has not objected within 45 days of acknowledging the bill is liable for the full amount billed up to the applicable fee schedule maximum, and the Board will not review any objection made after that point. Providers can file Form HP-1.0 through OnBoard to pursue it.
NYRx is the State-run Medicaid pharmacy program. Effective April 1, 2023 retail pharmacy was carved out of mainstream Medicaid managed care, HARP and HIV-SNP plans and is paid directly by the State. Behavioral health remains carved into the plan and family planning stays fee-for-service regardless of enrollment.
We serve practices and healthcare facilities statewide, including all five boroughs of New York City, Buffalo, Rochester, Yonkers, Syracuse, Albany, White Plains, New Rochelle, Schenectady and Utica.
