- 410 Peachtree Pkwy, Suite 4245 Cumming, GA 30041
- Email: info@prohealthcareadvisors.com
- Services
Medical Billing and Practice Management
Creative Collection Solution
MD Audit Shield – RAC
Physician Credentialing
EMR/EHR Software
Electronic Fund Transfer (EFT)
CodeMAXX Services
Hippa
Proven New York Medical Billing & Credentialing — Full-Cycle Revenue Management
New York medical billing is among the most complex in the nation — with eMedNY Medicaid managed care rules, OMIG audit requirements, and NYC-specific payer policies that differ from federal CMS guidelines.
Pro Health Care Advisors delivers end-to-end Revenue Cycle Management built specifically for New York providers. We focus on Payer Variance Detection, Denial Root-Cause Resolution, and Net Realized Revenue Growth.
Why Multi-Specialty New York Medical Billing Groups Choose Pro Health Care Advisors
Standard billing services focus on volume. We focus on Net Realized Revenue.
We provide the middle-office and back-office infrastructure to handle New York medical billing complexity — from NYC hospital-based practices to upstate independent clinics across 30+ specialties.
Payer Variance Detection
Are you actually being paid your contracted rates? We audit remittances against fee schedules to identify New York payer underpayments.
We initiate recoupment — recovering revenue most NY practices assume is gone for good.
Multi-Location Scalability
Whether you operate 2 locations or 20, our platform provides unified reporting and centralized AR management.
Location-specific tracking covers all your New York sites — from Manhattan to Long Island to Upstate.
Accounts Receivable Recovery
We specialize in aging AR (120+ days) that internal teams have written off.
On average, we recover 60–75% of balances deemed uncollectible by New York medical billing departments.
New York Medical Billing Compliance Expertise
From NY DOH Medicaid policy changes to OMIG audit triggers and payer-specific prior authorization rules, we stay ahead.
Your team can focus on patient care — not New York's complex regulatory environment.
EHR-Agnostic Integration
Epic, Cerner, Athena, AdvancedMD, Allscripts — we integrate directly into your existing New York workflow.
No costly system migrations or disruptions to care delivery for NY practices of any size.
Dedicated Account Management
You're not a ticket number. Every New York client has a dedicated Account Manager and specialty-specific billing experts.
Not a generic call center — a named specialist who knows your practice and NY payer mix.
9 Comprehensive New York Medical Billing Services for Healthcare Organizations
Standard vendors process claims. Pro Health Care Advisors engineers revenue integrity.
Our New York medical billing services are designed for organizations that require specialty-specific expertise, EHR interoperability, and measurable yield improvement.
Charge Capture & Entry
Eliminating manual data-entry errors through automated HL7/FHIR EHR integration.
Real-time validation ensures CPT/ICD-10 accuracy before claims reach the New York clearinghouse.
New York Medical Billing Coding Services
Certified coders (CPC, CCS, COC) across 20+ specialties. We optimize modifier strategy, audit for upcoding risk, and ensure compliance with LCD/NCD requirements.
Claims Submission & Clearinghouse
98%+ clean claim rate powered by proactive, specialty-specific scrubbing algorithms.
We manage payer portals, EDI rejections, and resubmission workflows so your New York team doesn't have to.
Payment Posting & Reconciliation
Automated ERA/EOB processing with variance flagging.
When contracted rates don't match remittance, we catch it and challenge it with payer-level dispute filing.
Denial Management & Appeals
Root-cause engineering to eliminate repetitive denials — we fix the workflow causing the denial, not just appeal it.
We recover "lost" aging AR from all New York payers including eMedNY and Medicare.
Accounts Receivable Follow-Up
High-touch collections for balances 90+ days. We specialize in "old AR" that internal teams have written off.
Our New York medical billing recovery team pursues revenue assumed unrecoverable from all NY payers.
Patient Billing & Collections
HIPAA-compliant, empathy-driven patient communications.
From statement generation to payment plan management, we protect your New York brand while optimizing patient collections.
Credentialing & Payer Enrollment
Scale your New York provider count without administrative lag.
We handle CAQH, eMedNY enrollment, re-credentialing cycles, and roster updates across all major New York carriers.
RCM Analytics & Reporting
Real-time dashboards tracking Days in AR, Net Collection Rate, Denial Rate by Category, and Payer-Specific Performance.
Data you can act on — not vanity metrics that obscure your true New York medical billing performance.
Your New York Revenue Cycle Is Leaking.
We'll Show You Where.
Don't settle for a generic service quote.
Most New York healthcare organizations are losing 8–12% of potential revenue to payer underpayments, preventable denials, and aging AR write-offs.
Pro Health Care Advisors offers a complimentary Payer Performance Audit to benchmark your current New York medical billing performance against industry standards — and identify exactly where revenue is being left on the table.
No sales pitch. No obligations. Just data.
New York Medical Billing Across 30+ Healthcare Specialties
Every specialty has different coding requirements, medical necessity rules, and payer policies.
Our AAPC-certified coders are trained for your specific specialty — not generic New York medical billing.
New York Medical Billing for NYC Hospital-Based & Large Group Practices
New York City hosts the highest density of hospital-based practices in the US.
We handle complex facility and professional fee billing splits, global surgery billing, and multi-provider credentialing across all NYC boroughs. Learn more at NY DOH Medicaid.
Mental Health & Behavioral Health New York Medical Billing
New York's mental health parity enforcement is among the strictest in the nation.
Our coders specialize in behavioral health CPT documentation (90837, 90834, 90847), NY Medicaid managed care billing, and prior authorization workflows. See Medicaid mental health parity rules.
Telehealth New York Medical Billing — Parity Laws & Modifiers
New York enacted strong telehealth parity laws post-2020.
We manage POS 02/10 coding, GT/95 modifier requirements, and originating site billing across all NY payers. See the CMS Telehealth billing guidelines.
Major New York Medical Billing Payers — We Bill & Credential with All of Them
From eMedNY Medicaid to Empire BlueCross, Healthfirst, MetroPlus and all Medicare Advantage plans — our team manages New York medical billing and credentialing across the full payer mix.
| Payer | Plan Type | New York Role | Key Billing Note | Status |
|---|---|---|---|---|
| New York Medicaid (eMedNY) | State Medicaid | Largest state insurer in NY | Managed care enrollment, OMIG audit compliance | ✓ Full Service |
| Empire BlueCross BlueShield | Commercial / MA | Dominant commercial payer | Network credentialing, fee schedule variance review | ✓ Full Service |
| Medicare (JK MAC — CGS) | Federal Medicare | Part A & B — NY jurisdiction | Medical necessity documentation, LCD compliance | ✓ Full Service |
| Healthfirst (NYC) | Medicaid Managed Care / MA | Largest NYC Medicaid MCO | NYC-specific managed care billing rules | ✓ Full Service |
| MetroPlus Health Plan | Medicaid Managed Care | NYC Health + Hospitals MCO | NYC public hospital network enrollment | ✓ Full Service |
| United Healthcare / Optum | Commercial / MA | Major commercial presence in NY | Prior auth automation, value-based contracting | ✓ Full Service |
| Aetna / CVS Health | Commercial / MA | Employer & individual plans | Claims portal requirements, credentialing timelines | ✓ Full Service |
| Fidelis Care (Centene) | Medicaid / Child Health Plus | Upstate NY — large Medicaid MCO | Child Health Plus & Medicaid managed care billing | ✓ Full Service |
Getting Started with New York Medical Billing: Our 5-Step Onboarding Process
From your first free assessment through full revenue cycle management — a clear, proven process designed for busy New York providers.
Free AR Assessment
We analyze New York medical billing performance, payer mix, and denial rates — identifying exactly where revenue is being lost.
Credentialing Audit
We verify active credentials with all New York payers — catching gaps before they delay reimbursement.
EHR Integration
We connect to your existing EHR and PM system — no migration required to begin New York medical billing.
Active Billing & Compliance
CPC-certified coders manage claims from charge capture to payment posting with continuous compliance monitoring.
Monthly Reporting
Real-time dashboards and monthly reports with proactive New York medical billing optimization recommendations.
Built-In RAC Audit Defense for Every New York Medical Billing Client
Every New York client receives access to our MD Audit Shield program — proactive audit prevention and full federal and state audit defense included at no extra cost.
New York Medical Billing — Frequently Asked Questions
Yes. Our team is experienced with New York State Medicaid (eMedNY) billing — including NY Medicaid managed care (Healthfirst, Fidelis, MetroPlus, Molina, Amerigroup), OMIG audit compliance, and NY DOH prior authorization requirements.
We also manage coordination of benefits for dual-eligible patients. For official eMedNY provider information, visit NY DOH Medicaid (health.ny.gov).
New York payer credentialing timelines vary significantly:
NY Medicaid (eMedNY) typically takes 60–90 days, Medicare enrollment 60–120 days, and commercial payers like Empire BCBS, Healthfirst, and United Healthcare 90–180 days.
NYC Medicaid managed care organizations can take longer due to network review processes. Our credentialing team tracks every application proactively.
Absolutely. We have specific experience with facility and professional fee split billing, global surgery period management, multi-provider group billing, and hospital-based specialty practice revenue cycle management.
We serve large multi-specialty groups, hospital-affiliated practices, and health systems throughout New York City and Upstate New York.
New York Medical Billing — Expert Articles & Resources
Expert guidance on New York medical billing, credentialing, and compliance for healthcare providers.
New York Medical Billing Guide for eMedNY — What Providers Need to Know in 2025
eMedNY and NY Medicaid managed care plans have unique billing rules, prior authorization requirements, and OMIG audit triggers that differ significantly from CMS guidelines.
Get Free Assessment →Physician Credentialing Timeline in New York — NYC vs. Upstate Payer Breakdown
Credentialing timelines vary significantly between NYC managed care plans and Upstate New York commercial payers. Learn how to prevent costly New York medical billing gaps during enrollment.
Read Article →New York OMIG Audit Triggers — What NY Medicaid Providers Need to Know
The NY Office of the Medicaid Inspector General (OMIG) conducts aggressive compliance audits. This guide covers the top OMIG audit triggers and how proactive New York medical billing review prevents costly overpayment demands.
See CodeMAXX →Telehealth New York Medical Billing — Parity Laws, POS Codes & eMedNY Rules
New York's telehealth parity laws cover both commercial and Medicaid payers. Billing correctly across eMedNY, Empire BCBS, Healthfirst, and Medicare requires careful attention to POS 02/10 codes and GT modifiers.
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