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Revenue cycle management services
in Manhattan, NY
Qualigenix revenue cycle management services give Manhattan practices one team for eligibility, authorizations, coding, claims, payment posting, denials and A/R, so no handoff between vendors loses a claim. Pricing is a percentage of collections
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How Qualigenix serves Manhattan practices
Qualigenix runs the revenue cycle for Manhattan practices where a patient's coverage can change between two visits. Medicaid renewals, plan switches and the July 2026 Essential Plan cutback all show up first at the front desk, then later as denials. The statewide rules every New York practice works under, from eMedNY's filing window to prompt-pay deadlines and patient billing protections, are on our revenue cycle management services in New York page. This page covers the Manhattan side: which plans your patients carry and where revenue leaks between them. The back end gets the same attention: patient statements and payment plans follow the New York rules on the state page, and every balance is checked against the payer's final adjudication before a statement goes out. We work inside your existing EHR and report results by payer every month.
What revenue cycle management services does Qualigenix provide in Manhattan?
Qualigenix verifies insurance, secures prior authorizations, codes, bills, posts payments, works denials, recovers A/R and keeps providers credentialed for independent practices in Manhattan. The work covers every payer a New York County patient can carry, including seven Medicaid managed care plans, 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.
Revenue cycle management for New York County's Medicaid plans
Qualigenix routes each Manhattan Medicaid patient's eligibility check, authorization and claim to the plan that actually holds the member. In New York County that can be one of seven mainstream plans, a HARP product, one of three HIV Special Needs Plans or fee-for-service Medicaid.
Seven plans, seven rulebooks
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. Each sets its own authorization list, filing limit and appeal process. Qualigenix keeps those rules per plan, so a MetroPlusHealth authorization isn't requested on Healthfirst's terms.
Shifting Medicaid coverage
The NYC Health Department told providers in July 2026 that, starting as early as January 2027, many city Medicaid members ages 19 to 64 must meet community engagement requirements, and many will renew every six months instead of every year. The department asked practices to check coverage status and renewal timing at each appointment. Qualigenix runs that check before every visit through insurance verification and benefits, and flags patients whose renewal is coming up.
Statewide claim rules
Fee-for-service Medicaid claims go to eMedNY within 90 days of the date of service, and commercial plans must pay clean electronic claims within 30 days. Qualigenix tracks both for Manhattan claims the same way it does statewide, as explained on our New York revenue cycle management page.
RESULTS ACROSS 275+ PRACTICES
Results Manhattan practices can expect
Qualigenix reports the same revenue cycle metrics for every client. The figures below are company-wide results across our client practices, not Manhattan-only results.
98%
Claim accuracy
4.8%
Denial rate
97.7%
Net collections rate
Reduced from 54 to 36
Days in A/R
Reduced to 38%
A/R over 90 days
79%
Denials overturned
29-32%
Cash-flow improvement
$923M+
Accounts receivable recovered
PROVEN TRACK RECORDHIPAA-Compliant Revenue Cycle
275+ ClinicsGETTING STARTED
How onboarding works
Qualigenix takes over a Manhattan practice's revenue cycle in four steps and goes live by day 6.
01
Revenue Cycle Review
Onboarding call. We review your billing setup, payer mix and denial trends by plan.
02
EHR and portal setup
Software and portal setup inside your existing EHR, plus access to each Medicaid plan, NGS and commercial payer portal.
03
Account clean-up
Open claims, unposted payments and stalled authorizations are sorted by payer and age.
04
Go live by day 6
Go live by day 6, with front-end checks, claims and A/R running under one team.
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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.
One end-to-end team
Qualigenix handles every step from the eligibility check to the posted payment. When a claim denies, the same team fixes the step that caused it.
Any EHR
Qualigenix works in 133 EMR/EHR platforms. Your staff keep their system, and our team works in it directly instead of through exports.
Payer-level reporting
You get collections, denial rate, days in A/R and authorization turnaround by payer each month. Problems with a single Manhattan plan show up in the numbers right away.
Go live by day 6
Qualigenix goes live on day 6 on average. Account clean-up starts during onboarding, so older claims start moving before go-live.
HAVE QUESTIONS?
Frequently Asked Questions
Frequently asked questions about our setup and support in Manhattan.
It covers insurance verification, prior authorization, coding, billing, payment posting, denial management, A/R recovery and credentialing. One team runs all eight, so nothing gets lost between vendors. Ask a revenue cycle specialist which parts your practice needs most.
Yes. Qualigenix requests and tracks authorizations for New York County's Medicaid plans, the HIV Special Needs Plans, Medicare Advantage and commercial payers. Each request is tracked against the plan's decision deadline.
The NYC Health Department expects many city Medicaid members to face community engagement requirements and six-month renewals starting as early as January 2027. Patients who lose coverage between visits create denials. Qualigenix checks coverage before every appointment and flags upcoming renewals.
We follow up on every unpaid claim daily, sorted by payer and age, and fix denial causes at the source. Across our clients, days in A/R dropped from 54 to 36. Book a meeting to review your aging report.
Qualigenix charges a percentage of collections, so our fee depends on what your practice collects. The exact percentage depends on specialty, volume and payer mix. A revenue cycle specialist can quote it after reviewing your numbers.
Qualigenix goes live by day 6 on average. Your current open claims and A/R are cleaned up during onboarding, so the switch doesn't stall cash.
No. What matters is whether the team knows Manhattan's payers, from seven Medicaid plans and three HIV Special Needs Plans to NGS and commercial carriers. Qualigenix works all of them inside your EHR. Book a meeting to see how that would work for your practice.