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Medical Billing Company in New York City
Vector Medical Billing works from 15717 85th Street in Jamaica, Queens. New York City practices bill a payer mix that is unusual even for New York State: Medicaid managed care plans built around the city’s hospitals, union benefit funds, a large share of no-fault auto claims, and the Workers’ Compensation Board. New York practices pay a flat monthly or per-claim fee, not a percentage.
98%Published NCR
24hClaim Submission
BAASigned with every client
AAPCCertified coders
AHIMACertified coders
E&OErrors and omissions insured
50 StatesRemote billing nationwide
Jamaica, Queens
What NYC practices bill that other places do not
The same five boroughs can produce six kinds of payer on one day’s schedule.
Most New York City Medicaid patients are in managed care, so their claims go to the plan, not to eMedNY: Healthfirst, Fidelis Care, MetroPlusHealth (owned by NYC Health + Hospitals), EmblemHealth, Anthem Blue Cross and Blue Shield HP, UnitedHealthcare Community Plan, and Molina. The same plans run Essential Plan and Child Health Plus products, each with its own eligibility and authorization rules.
Commercial volume includes EmblemHealth’s GHI plans, which cover many New York City employees and retirees, and union funds such as the 1199SEIU National Benefit Fund, which pays its own claims. Medicare Part A and Part B go to National Government Services, Jurisdiction K, the same as the rest of the state. The New York State page covers eMedNY corrections and the neighboring states.
What a NYC engagement covers
- Medicaid managed care, Essential Plan, and Child Health Plus claims sent to the right plan
- No-fault claims inside the 45-day window
- Workers’ compensation bills under the Board’s medical fee schedule
- A flat monthly or per-claim fee, set in writing
Where a New York City claim goes
Sending a claim to the wrong one of these is the most common NYC denial.
| Payer | Where the claim goes | Filing rule |
|---|---|---|
| Medicare Part A and B | National Government Services, Jurisdiction K | 12 months from the date of service |
| Fee-for-service Medicaid | eMedNY | 90 days from the date of service (18 NYCRR 540.6) |
| Medicaid managed care plans, such as Healthfirst and Fidelis Care | The plan, not eMedNY | The plan’s provider contract and manual |
| Essential Plan and Child Health Plus | The plan that issued the card | The plan’s provider contract |
| No-fault auto | The auto insurer, on an NF-3 or CMS-1500 | 45 days from the date of service (11 NYCRR 65-1.1) |
| Workers’ compensation | The carrier or self-insured employer, under Workers’ Compensation Board rules | The Board’s medical fee schedule ground rules |
| Union benefit funds | The fund itself, such as the 1199SEIU National Benefit Fund | The fund’s provider rules |
Practices in Brooklyn, Manhattan, the Bronx, Staten Island, Long Island, and Westchester work under the same payer rules and the same team.
NYC claim rules that cost practices money
Each of these is specific to New York, and most are specific to the city’s payer mix.
No-fault’s 45-day clock
Under New York’s no-fault regulation (11 NYCRR 65-1.1), the provider’s bill is due within 45 days of the service. No-fault pays at the workers’ compensation fee schedule, and a denial goes to arbitration or court, not a plan appeal.
Workers’ compensation authorization
Outside an emergency, only providers authorized by the New York Workers’ Compensation Board can treat and bill for a work injury, and bills follow the Board’s medical fee schedule.
The plan, not eMedNY
A Medicaid managed care claim sent to eMedNY is denied. eMedNY is for fee-for-service Medicaid, with a 90-day initial filing limit.
Surprise bills and IDR
New York’s surprise bill law (Financial Services Law Article 6) has its own dispute resolution for state-regulated plans. Self-funded employer plans use the federal No Surprises Act process instead. See out-of-network and IDR.
More than one borough
Each office address has to match the payer enrollment. A group that opens a Brooklyn office and bills it under the Queens address gets location denials. Medicare requires a new practice location to be reported within 30 days.
How New York practices pay
New York’s fee-splitting rule (8 NYCRR 29.1(b)(4)) and its Medicaid billing-service rule (18 NYCRR 504.9) do not allow a billing fee tied to collections. NYC practices pay a flat monthly or per-claim fee.
Fees and separate work
How a New York City engagement is priced.
Written rate
A flat monthly fee or a per-claim fee, set in writing after the free audit. No setup fee on the monthly cycle. Month to month, with 30 days’ written notice.
Separate work
Credentialing with NYC plans, Workers’ Compensation Board authorization paperwork, no-fault arbitration filings, and old A/R are scoped on their own.
Audit a NYC payer mix
Send monthly visits by payer, including no-fault and workers’ compensation, and your EHR name. We report misrouted claims, open no-fault and plan A/R, and a written flat or per-claim rate.
Written
Monthly rate
98%
Published NCR
50
US States
BAA
Every Client
New York City billing questions
Straight answers for practices in the five boroughs.
Is Vector Medical Billing based in New York City?
Yes. The office is at 15717 85th Street, Jamaica, NY 11414, in Queens. Billing work is remote, so practices across the five boroughs, Long Island, and Westchester work with the same team.
How do New York City practices pay for medical billing?
A flat monthly fee or a per-claim fee, never a percentage of collections. New York’s fee-splitting rule and its Medicaid rule for billing services do not allow a fee tied to collections.
Do you bill no-fault claims in New York?
Yes. The bill goes to the auto insurer on an NF-3 or CMS-1500 within 45 days of the service, priced at the workers’ compensation fee schedule. Denials go to arbitration or court.
Where does a Healthfirst or MetroPlusHealth claim go?
To the plan. Medicaid managed care, Essential Plan, and Child Health Plus claims go to the plan that issued the card. Only fee-for-service Medicaid goes to eMedNY.
Who is the Medicare contractor for New York City?
National Government Services, Jurisdiction K, for Medicare Part A and Part B across New York State.
Do we have to change our EHR?
No. Billers work in the system that already holds the encounters.