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Medical billing services
in Manhattan, NY
Qualigenix medical billing services get Manhattan practices paid by Medicaid plans, Medicare and commercial insurers, with one team handling each claim from the eligibility check to the posted payment. Pricing is a percentage of collections.
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How Qualigenix serves Manhattan practices
Qualigenix bills for Manhattan practices whose payer mix looks like few other counties in the country. MetroPlusHealth, Healthfirst, EmblemHealth and Fidelis Care all write Medicaid coverage here, national carriers sell commercial plans next to them, and HIV Special Needs Plans add another set of plan rules. The statewide rules every New York claim follows, from eMedNY's filing window to commercial prompt-pay deadlines, are on our medical billing services in New York page. This page covers what changes when your patients carry New York County coverage. Our billers work inside your current EHR, so your front desk keeps its routine and nobody retrains on new software.
What medical billing services does Qualigenix provide in Manhattan?
Qualigenix checks eligibility, reviews coding, scrubs and submits claims, posts payments, appeals denials and works aged A/R for independent practices in Manhattan. We bill all payers, including the seven mainstream Medicaid managed care plans in New York County, the city's three HIV Special Needs Plans and Medicare through National Government Services.
Claims are scrubbed and tracked across all major commercial and government payers in New york.
Medical billing for New York County's Medicaid plans
Qualigenix sends every Manhattan Medicaid claim to the payer that actually holds the member. A Manhattan Medicaid patient can sit in any of seven mainstream managed care plans, one of three HIV Special Needs Plans, or fee-for-service Medicaid billed through eMedNY. A claim sent to the wrong one comes back denied and burns days against the filing clock.
Seven plans, seven contracts
State Department of Health listings show seven mainstream Medicaid managed care plans in New York County: Anthem Blue Cross and Blue Shield HP, EmblemHealth, Fidelis Care, Healthfirst, MetroPlusHealth, Molina Healthcare (also called Affinity by Molina Healthcare) and UnitedHealthcare. Most also offer Health and Recovery Plans (HARP) for members with serious mental illness or substance use disorders, along with Child Health Plus. Each plan contract sets its own filing limit. EmblemHealth, for example, won't pay a claim filed more than 120 days after the date of service. Qualigenix loads each contract's limit into claim tracking, so every claim is chased against the right deadline.
HIV Special Needs Plans
New York City has three HIV Special Needs Plans: Amida Care, MetroPlusHealth Partnership in Care and SelectHealth from VNS Health. Their members carry a different plan ID than mainstream plan members, and their claims must go to the SNP. Qualigenix flags SNP enrollment at the eligibility check and confirms any plan-specific prior authorization before the visit, so services don't get denied after the fact.
Statewide filing rules
Fee-for-service Medicaid claims go to eMedNY within 90 days of the date of service, and later claims need an approved delay reason. Qualigenix tracks that window for Manhattan claims the same way it does across the state, as described on our New York medical billing page.
RESULTS ACROSS 275+ PRACTICES
Results Manhattan practices can expect
Qualigenix reports the same metrics for every client. The figures below are company-wide averages across our client practices, not Manhattan-only results.
98%
Clean-claim rate on first submission
36 days
Average collection cycle
29-32%
Average cash-flow improvement
$50M+
A/R recovered for client practices
4.8%
Denial rate
79%
Denials overturned
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ ClinicsGETTING STARTED
How onboarding works
Qualigenix moves Manhattan practices to live billing in six steps, with a 6-day average from kickoff to go-live.
01
Kickoff and EHR access
Kickoff call, signed BAA and access to your existing EHR. There's no software change.
02
Payer enrolment check
We verify your enrollment with each Medicaid plan, NGS and your commercial payers, then set up payer accounts.
03
Coder and scrub rules
A coder for your specialty is assigned, and scrub rules are built for each plan you bill.
04
EDI, ERA and EFT setup
EDI, ERA and EFT routing is set up and tested with a live transaction.
05
Validation batch
A validation batch goes out, with a pre-claim check on every line.
06
Go live, A/R in parallel
We go live and work your legacy A/R in parallel, so older claims don't stall while new ones start.
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WHY PRACTICES CHOOSE QUALIGENIX
Why Manhattan practices choose Qualigenix
Independent clinics and specialty practices in Manhattan trust Qualigenix for dedicated claim support.
Certified coders, dedicated billers
Qualigenix assigns a named biller and a specialty-certified coder to each account. They learn your providers, your plans and your denial patterns, so you aren't explaining your practice to someone new every month.
Works in your EHR
Qualigenix works in 133 EMR/EHR platforms. Your staff keep the system they know, and we bill from it directly, with no exports and no duplicate charge entry.
Clear monthly reporting
Each month you get collections, denial rate, days in A/R and results by payer. Every metric is defined in writing, so you can check the math yourself.
6-day onboarding
Qualigenix takes six days on average to go live. Your legacy A/R is worked in parallel, so cash from older claims keeps arriving while new claims start.
HAVE QUESTIONS?
Frequently Asked Questions
Frequently asked questions about our setup and support in Manhattan.
Qualigenix bills all of them: Anthem Blue Cross and Blue Shield HP, EmblemHealth, Fidelis Care, Healthfirst, MetroPlusHealth, Molina Healthcare and UnitedHealthcare, plus their HARP products, the three HIV Special Needs Plans and fee-for-service Medicaid through eMedNY. Tell us which plans you're contracted with and we'll map your claims.
Yes. Qualigenix bills Amida Care, MetroPlusHealth Partnership in Care and SelectHealth from VNS Health. We confirm SNP enrollment at the eligibility check, because a claim sent to a mainstream plan for an SNP member will deny. A billing specialist can walk through your current SNP claims with you.
We track every claim against its own deadline: 90 days from the date of service for eMedNY, and each plan's contract limit for managed care. Claims nearing a limit go to the top of the daily work queue. Ask us how many of your open claims are close to a deadline.
National Government Services processes traditional Medicare Part A and Part B claims for New York under Jurisdiction K. Medicare Advantage and integrated dual-eligible claims go to the patient's plan instead. Qualigenix sorts each claim to the right payer before it's submitted.
Qualigenix charges a percentage of collections, so our fee rises and falls with what your practice collects. The exact percentage depends on your specialty, claim volume and payer mix. A billing specialist can quote it after reviewing your numbers.
No. What matters is whether the team knows Manhattan's payers: seven mainstream Medicaid plans, three HIV Special Needs Plans, NGS for Medicare and the integrated dual-eligible plans. Qualigenix bills all of them and works inside your existing EHR. Book a meeting to see how that would work for you.
Yes. Qualigenix signs a business associate agreement before accessing any patient data. You can review the BAA with a billing specialist during your first meeting.