Medicaid rules and supplier requirements vary sharply by state, and no post-hoc documentation rescues a claim. In New York that plays out against a specific set of rules rather than a general one.
Medicare DMEPOS claims for beneficiaries who live in New York go to Noridian Healthcare Solutions (DME MAC Jurisdiction A), the DME contractor for the beneficiary's state of residence, which also hears the first level of appeal. A supplier shipping to patients in several states deals with each state's DME contractor.
At a glance
Coding driver
HCPCS coding tied to an order, a face-to-face encounter, and a medical-necessity record that must exist before delivery.
Medicare contractor
Noridian Healthcare Solutions (DME MAC Jurisdiction A)
Medicaid program
New York Medicaid
Auto injuries
No-fault — auto carrier pays first
What changes in New York
Medicaid in New York runs as New York Medicaid and is delivered largely through commercial managed care plans, so most Medicaid claims are adjudicated by an insurer with its own filing window and its own authorization rules rather than by the state.
New York is a no-fault state. For an auto injury the auto carrier is the payer of first resort, not the health plan, and billing the health plan first produces a denial that looks like a coverage problem but is a sequencing problem.
New York does not permit billing companies to be compensated as a percentage of collections. Our own pricing in New York is set accordingly. That describes what we charge; your own position is a question for your counsel rather than for us.
Where durable medical equipment claims fail
- Documentation assembled after delivery
- Missing face-to-face encounter record
- Item not covered under the state plan
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at your New York durable medical equipment denials.
Scope
A written scope and price before any work starts.
Transition
Coding and submission move across without a gap.
Report
Denial causes segmented by payer and provider.
Durable Medical Equipment Billing in New York — Frequently Asked Questions
Do durable medical equipment billing rules differ in New York?
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Yes. New York runs no-fault auto coverage, which changes who pays first for an injury claim — and that matters more in durable medical equipment than in most specialties. Medicaid runs as New York Medicaid, delivered largely through commercial managed care plans. So most New York Medicaid claims are adjudicated by an insurer with its own filing window, its own authorization rules, and its own appeal path — not by the state. Nationally about 78% of Medicaid beneficiaries sit in comprehensive managed care, and five companies hold roughly half of that enrollment.
Which Medicare contractor handles New York durable medical equipment claims?
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Noridian Healthcare Solutions (DME MAC Jurisdiction A). Medicare assigns DMEPOS claims by the beneficiary's permanent address, so this is the contractor for patients who live in New York, whatever state the supplier is in. It processes the claims, publishes the DME local coverage determinations with the other DME contractors, and hears the first level of appeal.
What makes durable medical equipment claims deny in New York?
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The specialty causes first: documentation assembled after delivery; missing face-to-face encounter record; item not covered under the state plan. On top of those, New York Medicaid runs through commercial plans, so filing windows and authorization rules vary by plan rather than by program.
How are auto injuries handled for durable medical equipment in New York?
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New York is a no-fault state. For an auto injury the auto carrier is the payer of first resort, not the health plan. Billing the health plan first produces a denial that reads like a coverage problem but is a sequencing problem, and by the time it arrives the auto carrier's own window has been running.
Are your durable medical equipment coders certified?
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Yes. All coding is performed by certified coders credentialed through the AAPC or AHIMA, working from the documentation you provide. HCPCS coding tied to an order, a face-to-face encounter, and a medical-necessity record that must exist before delivery.
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