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Medical Coding Services
in Manhattan, NY
Qualigenix medical coding services give Manhattan practices CPC and CCS certified coders who code each chart to the payer that will pay it, whether that's a Medicaid plan, Medicare or a commercial insurer. Pricing is a percentage of collections.
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How Qualigenix serves Manhattan practices
Qualigenix codes for Manhattan practices whose charts go to many payers in one week. A single schedule can include a MetroPlusHealth Medicaid patient, an Amida Care member, a Medicare patient covered under National Government Services policy and an employer plan through EmblemHealth. Each of those payers reads the same code differently. The New York rules that apply everywhere in the state, including eMedNY's edits and Medicaid documentation audits, are on our medical coding services in New York page. This page covers what Manhattan's payer mix adds. Our coders work inside your existing EHR and send coding questions back to your providers there.
What medical coding services does Qualigenix provide in Manhattan?
Qualigenix reviews documentation, assigns ICD-10-CM, CPT and HCPCS codes, checks modifiers and medical necessity, sends compliant provider queries and runs two levels of QA for Manhattan practices. Coders apply the policies of the payer on each claim, from New York County's Medicaid plans to National Government Services' Medicare coverage rules.
Claims are scrubbed and tracked across all major commercial and government payers in New york.
Medical coding for New York County's Medicaid plans
Qualigenix codes each Manhattan Medicaid chart to the policies of the plan holding the member. New York County patients can be enrolled in seven mainstream plans, in HARP behavioral health products or in an HIV Special Needs Plan, and each publishes its own coding and reimbursement policies.
Seven plan policy sets
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 and UnitedHealthcare. Most also offer Health and Recovery Plans (HARP) for members with serious mental illness or substance use disorders. A code combination one plan pays can trip another plan's edits. Qualigenix keeps a policy file per plan and checks each chart against the plan on the claim, not a generic Medicaid rule set.
HIV SNP charts
Amida Care, MetroPlusHealth Partnership in Care and SelectHealth from VNS Health are New York City's three HIV Special Needs Plans. SNP members often have several chronic conditions documented in one visit, so diagnosis order and specificity carry more weight. Qualigenix coders capture every documented condition to its full specificity and query the provider when the note doesn't support a code, through denial management feedback when a plan pushes back.
Statewide coding rules
New York Medicaid denies claims when an ordering, prescribing or referring provider on the claim isn't enrolled in the program, and the remittance shows adjustment reason B7. Qualigenix checks that provider's enrollment during coding review, the same way it does statewide, as covered on our New York medical coding page.
RESULTS ACROSS 275+ PRACTICES
Results Manhattan practices can expect
Qualigenix measures coding quality the same way for every client. The figures below are company-wide results across our client practices, not Manhattan-only figures.
98.9%
Coding accuracy
98.9%
Post-audit coding accuracy
98.6%
Audit pass rate
Reduced to 2%
Coding-related denials
300,000+
Charts audited per quarter
Reduced to under 1%
Compliance risk
2M+
Charts coded to date
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ ClinicsGETTING STARTED
How onboarding works
Qualigenix brings Manhattan practices onto coding in six steps, with a 6-day average from kickoff to live coding.
01
Kickoff and coding scope
Kickoff call, signed BAA and SLA, and scope: which encounter types and code sets we'll handle.
02
Specialty coders assigned
Coders are assigned by specialty, and chart intake is connected to your EHR.
03
Your coding playbook
We build your coding playbook, including New York Medicaid, Medicare and commercial payer rules.
04
Documentation review and queries
Coders start documentation review and send provider queries where notes fall short.
05
Coding with two-level QA
Codes are assigned and each chart passes two levels of quality review.
06
Go live with denial feedback
Go live with a daily export to billing. Denials come back to coders so the same error doesn’t repeat.
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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.
Specialty-certified coders
Every Qualigenix coder holds a CPC or CCS credential and is assigned by specialty. Your coder learns your providers' documentation habits and the payers you bill most.
Coding in your EHR
Qualigenix codes inside 133 EMR/EHR platforms. Providers answer queries where they already chart, and nobody exports files or re-keys codes.
Two-level QA
Each chart gets a peer or auditor review plus statistical sampling. Accuracy is scored by coder and specialty, so problems show up before a payer audit does.
Live in 6 days
Qualigenix starts coding live charts six days after kickoff on average. The playbook for your payers is built during those six days, not after.
HAVE QUESTIONS?
Frequently Asked Questions
Frequently asked questions about our setup and support in Manhattan.
Yes. Qualigenix codes for all seven mainstream plans in New York County, their HARP products and the three HIV Special Needs Plans. Coders check each chart against the policy of the plan on the claim. Ask a coding specialist which of your plans cause the most edits.
Coders match diagnoses to procedures using the local coverage determinations of National Government Services, the Medicare contractor for New York. When a note doesn't support medical necessity, the coder queries the provider before the claim goes out. We can review a sample of your Medicare denials with you.
Yes. Every coder holds a CPC or CCS credential and is assigned to your specialty. Charts also go through two levels of QA before release.
Yes. Qualigenix runs prospective audits before claims go out and retrospective audits on paid claims, with results scored by coder and specialty. Book a meeting to set the audit scope.
Qualigenix codes ICD-10-CM, ICD-10-PCS, CPT and HCPCS Level II. The encounter types we code are set at kickoff, based on the services your practice provides.
Qualigenix charges a percentage of collections. The exact percentage depends on your specialty, chart volume and payer mix. A coding specialist can quote it after a short review.
No. What matters is whether your coders know the policies of the payers on your claims: New York County's Medicaid plans, the HIV Special Needs Plans, NGS for Medicare and commercial carriers. Qualigenix codes to all of them inside your EHR. Book a meeting to see how it would work for your charts.