Predominantly government-funded, so the state Medicaid structure and managed care penetration shape the payer mix directly. 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
Episode-based billing where the physician must certify and re-certify the plan of care inside defined windows.
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 home health claims fail
- Physician did not certify the plan of care inside the window
- Face-to-face encounter not documented
- Visit frequency exceeding the plan of care
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 home health 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.
Home Health Billing in New York — Frequently Asked Questions
Do home health 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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