New York Medicaid — New York State Medicaid
| Program name | New York State Medicaid |
|---|---|
| Provider portal | https://www.emedny.org |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 90 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the New York Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in New York
The Blue Cross Blue Shield Association licensee in New York is Empire BlueCross BlueShield (Elevance Health). See the Anthem (Elevance Health) payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in New York
The dominant commercial insurers operating in New York, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in New York
New York State Medicaid contracts with the following managed-care organizations to administer Medicaid benefits in New York. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in New York
Wellpoint Federal is the Medicare A/B MAC for New York: Part A and Part B fee-for-service claims from New York go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to Noridian Healthcare Solutions, LLC as the DME MAC. Home health and hospice claims are processed by Wellpoint Federal. In the current Medicare Coverage Database export, 147 active LCDs from these contractors apply to New York claims.
- Wellpoint Federal
A/B MAC (Part A and Part B claims); Home health and hospice MAC
- Noridian Healthcare Solutions, LLC
DME MAC (durable medical equipment and supplies)
Selected active Wellpoint Federal policies for New York
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L33627 Non-Invasive Vascular Studies
- L33394 Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
- L35936 Facet Joint Interventions for Pain Management
- L39036 Epidural Steroid Injections for Pain Management
- L35000 Molecular Pathology Procedures
- L33577 Transthoracic Echocardiography (TTE)
- L33631 Outpatient Physical and Occupational Therapy Services
- L33632 Psychiatry and Psychology Services
- L33557 Cardiac Catheterization and Coronary Angiography
- L33569 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
- L33636 Routine Foot Care and Debridement of Nails
- L33622 Pain Management - Injection of tendon sheaths, ligaments, bursa, and ganglion cysts
Equipment, home health and hospice policies that apply in New York
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L33792 Wheelchair Options/Accessories
- L33797 Oxygen and Oxygen Equipment
- L33393 Hospice - Determining Terminal Status
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting New York billing
- NY Financial Services Law Article 6 (Surprise Bill / OON IDR — 'Emergency and Surprise Medical Bills')
- NY Insurance Law §3224-a (prompt pay — 30 days electronic / 45 paper)
- NY SB-6522A / Hospital Financial Assistance Law (hospital charity care standards)
Provider licensing & enrollment in New York
Providers enroll with NYS Medicaid via eMedNY Provider Enrollment. NYS also requires Medicaid Managed Care credentialing via each MCO; most use CAQH ProView.
Major health systems headquartered in New York
| Health system | Headquarters |
|---|---|
| Northwell Health | New Hyde Park, NY |
| NewYork-Presbyterian | New York, NY |
| Mount Sinai Health System | New York, NY |
| NYU Langone Health | New York, NY |
| Montefiore Health System | Bronx, NY |
Frequently asked questions — New York billing
What is the New York Medicaid program called?
New York's Medicaid program is known as New York State Medicaid. Providers enroll and manage claims through the provider portal at https://www.emedny.org.
What is the New York Medicaid timely filing limit?
New York State Medicaid requires initial claims to be filed within 90 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; New York's 90-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does New York Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for New York State Medicaid. Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in New York?
The dominant commercial payers in New York include Anthem (Elevance Health), UnitedHealthcare, Aetna, EmblemHealth, Cigna, along with the BCBS licensee Empire BlueCross BlueShield (Elevance Health). Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in New York?
New York State Medicaid contracts with 5 Medicaid MCOs tracked in the QuickIntell registry, including Centene, UnitedHealthcare, Molina Healthcare, EmblemHealth, Anthem (Elevance Health). MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in New York?
New York has 3 tracked state-level statutes that affect medical billing and RCM: NY Financial Services Law Article 6 (Surprise Bill / OON IDR — 'Emergency and Surprise Medical Bills'); NY Insurance Law §3224-a (prompt pay — 30 days electronic / 45 paper); NY SB-6522A / Hospital Financial Assistance Law (hospital charity care standards). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in New York with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to New York State Medicaid and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from New York Medicaid and the member ID card before submission.