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.
Claims for New York providers are adjudicated by National Government Services (JK), which is also who hears the first level of appeal — so an appeal argument that works here works in every state that contractor covers.
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
National Government Services (JK)
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. New York Medicaid is delivered through commercial managed care plans, each setting its own filing window and authorization rules.
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