Guides New York and Long Island
Medical billing on Long Island: how to choose a biller
The short answer
Long Island practices bill a mix of Medicaid managed care, the state Empire Plan, union funds and employer plans, and New York’s claim rules apply to only some of them. Choose a biller who can tell you, plan by plan, which rules apply.
A good Long Island biller knows the plans your patients actually carry and which rules apply to each one. Nassau and Suffolk practices bill a large Medicaid managed care population, the New York State Empire Plan, union benefit funds and employer plans. New York’s prompt-pay and claim-deadline law covers insurers the state regulates, not self-funded employer plans. A biller who treats every card the same will miss deadlines on some and leave interest unclaimed on others.
This guide covers the Long Island plan landscape with sources, why plan type matters, and what to look for in a biller here.
The plans Long Island patients carry
Medicaid managed care in Nassau and Suffolk
More than 414,000 people in Nassau and Suffolk were enrolled in mainstream Medicaid managed care in September 2026, across six main plans.
| Plan (September 2026) | Nassau | Suffolk |
|---|---|---|
| Healthfirst | 68,730 | 99,132 |
| Fidelis Care | 57,784 | 66,455 |
| Anthem Blue Cross and Blue Shield | 25,410 | 11,057 |
| HIP of Greater New York (EmblemHealth) | 13,563 | 16,671 |
| UnitedHealthcare | 8,542 | 17,767 |
| Molina Healthcare of New York | 8,184 | 20,943 |
| County total | 182,234 | 232,025 |
Source: NYS Department of Health, Medicaid managed care enrollment report, September 2026. The Nassau total also includes a small number of members in other plans. Another 9,372 people across the two counties were in Health and Recovery Plans (HARPs), the state’s behavioral health managed care product.
What this means for billing: each of these plans has its own provider manual, its own authorization rules and its own enrollment process. Being enrolled with New York Medicaid doesn’t make you in-network with a managed care plan. A biller should know which of these plans you’re contracted with and keep each plan’s rules on file.
The Empire Plan (NYSHIP)
The Empire Plan covers many New York State and participating local government employees and retirees. It is run as separate programs, and each one has its own administrator and claims address:
| Empire Plan program | Administrator (as of November 2026) |
|---|---|
| Medical/Surgical | UnitedHealthcare Insurance Company of New York |
| Hospital | Anthem Blue Cross |
| Mental Health and Substance Use | Carelon Behavioral Health |
| Prescription drugs | CVS Caremark |
Source: NYSHIP, Empire Plan contact information.
The practical point: a mental health claim and a medical claim for the same Empire Plan member go to different administrators. A biller who sends a therapy claim to the medical program gets a denial and loses days on the filing clock.
Union funds and employer plans
Many Long Island patients are covered through a union benefit fund or a large employer. These plans often write their own rules. The 1199SEIU Benefit Funds ask participating providers to submit clean claims within 90 days of the date of service (1199SEIU provider manual, as of November 2026). That is shorter than the 120-day minimum that applies to New York-regulated insurers, covered below.
Commercial plans
Commercial cards from carriers such as Anthem, UnitedHealthcare and Oxford, Aetna, Cigna and EmblemHealth cover both fully insured plans and self-funded employer plans that the carrier only administers. The carrier’s name on the card doesn’t tell you which. That distinction is the next section.
Why fully insured versus self-funded matters
New York’s main claim-payment law, Insurance Law §3224-a, applies to insurers, HMOs and other plans licensed by the state. For those plans, as of November 2026:
| Rule | What the law says |
|---|---|
| Claim submission deadline, §3224-a(g) | Providers get at least 120 days from the date of service to submit a claim. Medicaid managed care contracts may set a shorter period, but no less than 90 days. |
| Late claims, §3224-a(h) | A participating provider can ask the plan to reconsider a claim denied only for being late, if the delay came from an unusual occurrence and the provider usually files on time. The plan may cut payment by up to 25%, and can deny in full past 365 days. |
| Payment time, §3224-a(a) | Claims the plan clearly owes must be paid within 30 days if sent electronically, or 45 days on paper or fax. |
| Interest, §3224-a(c) | Late payment earns interest at the greater of the state’s corporate tax rate or 12% a year. |
Self-funded employer plans are different. The New York Department of Financial Services tells consumers that if an employer self-funds coverage and the employer, not an insurer, pays the claims, “New York requirements won’t apply” (DFS Know Your Rights notice). Those plans are governed by federal law (ERISA) and their own plan documents, so their filing limits and payment terms come from the plan, not from §3224-a.
For a Long Island practice this matters on two counts:
- Deadlines. If your biller assumes 120 days for every commercial card, claims for a self-funded plan with a shorter limit can be lost.
- Interest. On state-regulated plans, late payments carry interest. A biller who doesn’t track it leaves money unclaimed.
Ask the patient or the plan whether coverage is fully insured or self-funded, and record it with the insurance details. The full set of New York rules, including surprise bills and eMedNY, is in our guide to New York billing rules.
Map your own payer mix first
Before you talk to any biller, spend an hour on your own numbers. It makes every conversation shorter and shows you quickly who knows the region.
- Pull 12 months of remittances (835s or EOBs) from your clearinghouse, payer portals or current biller.
- Rank payers by dollars paid, and note what share of the total your top ten carry.
- For each one, write down the plan type: Medicaid managed care, Empire Plan program, union fund, fully insured commercial or self-funded.
- Note the filing limit from the plan’s provider manual or your contract, and whether you are in network.
- Mark the plans where denials cost you most.
Hand that page to every biller you interview and ask what they would do differently for each line.
What to look for in a Long Island biller
They know your payer mix by name. Send them your top ten payers by dollars and ask for the filing limit, the authorization rules that hit you most, and the enrollment status for each. A biller who knows the region answers most of that without looking it up.
They track plan type, not just carrier. Fully insured, self-funded, Medicaid managed care, Empire Plan program, union fund. Each has its own rules, and it should be a field in their system, not something a person remembers.
They handle enrollment with managed care plans. Adding a provider means separate enrollment with each Medicaid managed care plan and commercial carrier, on each plan’s own timeline. See credentialing timelines in New York.
Local helps, but check what “local” means. Claims are electronic, so a biller doesn’t need to be down the road to work them. Local knowledge of the plans is what pays. Some companies publish a page for every Long Island town without having anyone there; look for a real address, named people, and a phone number that reaches the team.
They pass the general vetting questions. Who picks the codes, who works your claims, what the fee covers and what happens when you leave. These apply anywhere; the full list is in our 12 questions to ask a medical billing company.
About Marlow
Marlow is a done-for-you billing company for independent practices, based on Long Island. Our billing manager has more than 20 years in medical billing across many types of practices and ran the billing team at Mount Sinai South Nassau, the Mount Sinai hospital in Oceanside. AI drafts the codes, your provider approves every one, and our billing team does the rest.
Sources
- NYS Department of Health, Medicaid managed care monthly enrollment report, September 2026
- EmblemHealth provider manual, provider networks and member benefit plans (HIP)
- NYSHIP, Empire Plan contact information
- 1199SEIU Benefit Funds provider manual, claims and reimbursement
- New York Insurance Law §3224-a
- NY Department of Financial Services, Know Your Rights (self-funded coverage)
General information, not advice on a specific claim, contract or legal question. Rules and rates change; check the linked sources for the current version.