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Radiology Billing Services in New York

Built for National Government Services’ Jurisdiction K rules, a 14-plan Medicaid managed care lineup, and a state that hasn’t yet joined interstate licensure, we keep New York radiology groups paid accurately and on time.

Radiology Billing Built Around New York's Realities

From Manhattan to the North Country, New York radiology groups bill against a seven-state Medicare jurisdiction, a Medicaid program that carved pharmacy out of managed care, and a licensure landscape still waiting on a compact vote.

Jurisdiction K Medicare rules shared across seven Northeastern states

14 mainstream Medicaid managed care plans statewide

21 critical access hospitals depend on clean radiology reimbursement

Still outside the interstate licensure compact, unlike most neighbors

Processed Claim Value
$ M+
Avg. A/R Collection Time
0 Days
Turn Around Time (TAT)
0 Hours
Client Retention Rate
0 %
Annual Claims
0 M+
First-Pass Claim Rate
0 %
Avg. Revenue Growth
8- 8 %
Avg. Denial Reduction
0 %

What Makes New York Radiology Billing Different

Four regulatory layers shape every claim we file for New York radiology practices.

Jurisdiction K Medicare Rules

National Government Services administers Medicare Part A and B claims for Jurisdiction K, covering Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont. Coverage determinations are set jurisdiction-wide, so an LCD update out of Boston applies just as directly to a radiology group in Buffalo. We track NGS’s specific bulletins so New York claims match the standard actually enforced.

NYRx Changed What Managed Care Covers

New York carved pharmacy benefits out of Medicaid managed care in April 2023, moving drug claims to the state-run NYRx fee-for-service program while medical and radiology benefits stayed with the 14 mainstream managed care plans, including Fidelis Care, Healthfirst, Excellus, and UnitedHealthcare. That split means a patient’s plan still governs their imaging claim, even though it no longer touches their pharmacy benefit.

Still Outside the Licensure Compact

Unlike most of its neighbors, New York has not joined the Interstate Medical Licensure Compact. Bills to enroll the state remain pending in the legislature as of the current session. Out-of-state radiologists reading New York studies still go through the state’s standard licensing process in full, with no compact fast-track, which stretches the credentialing timeline practices need to plan around.

30/45-Day Prompt Pay Rule

Under Insurance Law Section 3224-a, insurers must pay undisputed electronic claims within 30 days and paper claims within 45, with interest owed on anything paid late. If a plan can’t determine liability in time, it must notify the provider in writing within 30 days instead of letting the claim sit unanswered. We build New York claims clean on the first pass so they clear inside that window.

Complete Radiology Revenue Cycle Management

Certified CIRCC and CPC coders handle every CPT code, modifier, and global billing rule specific to diagnostic and interventional radiology — maximizing reimbursement on every encounter across all modalities and payer types.

Where New York Radiology Billing Breaks Down

A jurisdiction-wide Medicare standard, a managed care lineup split across pharmacy and medical benefits, and licensure that still runs the long way all add friction most billing teams aren’t built to absorb.

Before RBS

Jurisdiction K denials reworked from scratch every single time

Pharmacy and medical benefit splits confused at the claim level

Out-of-state radiologist credentialing stretching for months

Critical access hospital partners absorbing avoidable denials

Clean claims quietly missing the state's 30/45-day deadline

After RBS

Jurisdiction K appeals built on tracked NGS coverage patterns

Medical claims routed correctly under the post-NYRx plan split

Credentialing timelines planned for without a compact shortcut

Critical access hospital partners billing on margins that hold up

Every clean claim timestamped and chased before its deadline passes

Precision RCM & Coding Built for Radiology

Generic billing is the fastest way to a denied radiology claim. RBS delivers specialty-specific revenue integrity built for imaging’s TC/PC splits and modifier rules, so you capture every dollar you’re owed.

Diagnostic Radiology

CT Scan

MRI & MRA

Nuclear Medicine

PET / PET-CT

Ultrasound

Interventional Radiology

Teleradiology

Mammography

DEXA / Bone Density

Hospital Radiology

Radiation Oncology

Coverage Confirmed for Every Payer You Work With

From national carriers to regional Medicaid plans, coverage is checked against the exact payer, plan, and product type on file — never a generic match. Every result reflects current payer policy, not outdated data from months ago.
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana

Serving Radiology Practices Across New York

From New York City and Long Island to Buffalo, Rochester, and the North Country, we bill for radiology groups and their hospital partners across the state.

New York City Metro

Cities
  • New York City
  • Brooklyn
  • Queens
Counties
  • New York County
  • Kings County
  • Queens County
  • Bronx County
  • Richmond County

Long Island

Cities
  • Hempstead
  • Brookhaven
  • Babylon
Counties
  • Nassau County
  • Suffolk County

Hudson Valley

Cities
  • Poughkeepsie
  • Newburgh
  • White Plains
Counties
  • Westchester County
  • Dutchess County
  • Orange County

Capital Region & North Country

Cities
  • Albany
  • Saratoga Springs
  • Plattsburgh
Counties
  • Albany County
  • Saratoga County
  • Clinton County

Central New York & Southern Tier

Cities
  • Syracuse
  • Binghamton
  • Utica
Counties
  • Onondaga County
  • Broome County
  • Oneida County

Western New York & Finger Lakes

Cities
  • Buffalo
  • Rochester
  • Niagara Falls
Counties
  • Erie County
  • Monroe County
  • Niagara County

Wired Into Every System You Already Run

Your EHR, RIS, and PACS stay exactly as they are. We plug our coding workflow directly into what you already use — no migration, no new login for your radiologists, no disruption to how your team already works.

Built for Upstate New York's Dominant Regional Payer

Excellus BlueCross BlueShield is the dominant insurer across Central New York, Rochester, and the Southern Tier, a position it held through a 2024 rate dispute with Syracuse’s St. Joseph’s Health, resolved with a new multi-year contract in January 2025. A practice that can’t bill cleanly against Excellus is exposed on a large share of its Upstate volume. We build every claim to clear its requirements the first time.
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Frequently Asked Questions

What Medicare Administrative Contractor handles New York radiology claims?

National Government Services administers Medicare Part A and B claims for Jurisdiction K, which covers New York along with Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. We track NGS’s specific billing bulletins rather than generic national Medicare guidance.
Since April 2023, New York Medicaid pharmacy claims run through the state’s NYRx fee-for-service program instead of managed care. Medical and radiology claims still route through the patient’s mainstream managed care plan, one of 14 statewide, so eligibility checks need to track which benefit sits where.
Not yet. New York has not joined the Interstate Medical Licensure Compact, and bills to enroll the state are still pending in the legislature. Out-of-state radiologists need to complete New York’s standard licensing process in full before their reads can be billed under their NPI.
New York has 21 critical access hospitals, more than almost any other state, concentrated in rural counties with thin operating margins. Those hospitals depend on clean, accurately paid radiology claims, with very little room for denials or slow appeals to go unchallenged.
Yes. Excellus BCBS is the dominant insurer across Central New York, Rochester, and the Southern Tier, so a large share of our Upstate clients’ claims run through it. We build claims to its specific requirements rather than treating it as a generic commercial payer.

Get New York Radiology Billing That Keeps Up

From Jurisdiction K appeals to the post-NYRx managed care split, let’s talk about what’s actually slowing down your reimbursements.

Jurisdiction K and NGS-specific claim review

Medicaid eligibility tracked across the pharmacy and medical split

Out-of-state radiologist credentialing planned without a compact

Clean-claim tracking against the 30/45-day statutory deadline

Critical access hospital billing built for thin rural margins

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What Our Clients Say?

Rebecca Lawson

★★★★★

Radiology Practice Manager

Since partnering with your radiology billing team, our billing workflow has become much smoother. They understand imaging procedures, payer requirements, coding, and claim follow-ups. Their team is responsive, professional, and always stays on top of outstanding claims.

Dr. Christopher Bennett

★★★★★

Medical Director, Diagnostic Imaging Center

Your team truly understands the challenges of radiology billing. They handle claims accurately, follow up on unpaid accounts, and help resolve billing issues efficiently. Their expertise and communication have made our revenue cycle more organized and reliable.

Dr. Andrew Whitaker

★★★★★

Radiologist & Imaging Center Owner

Our team has been an excellent partner for our imaging center. They understand radiology billing, coding, claim submission, denials, and follow-ups. Their attention to detail and consistent communication have helped streamline our billing process and improve our revenue cycle.

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