New York has four regional Blue plans, six separately licensed therapy professions, and public coverage programs that reach well beyond Medicaid, and each one changes how a behavioral health claim has to be billed. A practice in Manhattan, Rochester, or Buffalo can be dealing with an entirely different set of payers under the same state law. Maximum Billing handles behavioral health and psychiatric billing for New York therapists, counselors, social workers, and group practices, so the right rules are applied to every claim from the start.
We bill for practices in New York and eleven other states. Schedule a consultation or call 800-820-0364.
Why New York Behavioral Health Billing Is Its Own Specialty
- The Blue plan depends on the region. Downstate New York and much of the eastern part of the state are served by Empire BlueCross BlueShield, while Excellus BlueCross BlueShield covers Rochester and Central New York, Highmark BlueCross BlueShield of Western New York covers the Buffalo area, and Highmark Blue Shield of Northeastern New York covers the Albany region. A client’s card, not the practice’s location, determines which one applies.
- Several New York-based plans are major payers. EmblemHealth, Healthfirst, and MVP Health Care sit alongside national carriers such as UnitedHealthcare and its Oxford plans, Aetna, and Cigna.
- Public programs go well beyond Medicaid. Medicaid, Child Health Plus, and the Essential Plan cover millions of New Yorkers, mostly through managed care plans.
- The state licenses six therapy professions separately. Mental health counselors, marriage and family therapists, creative arts therapists, psychoanalysts, clinical social workers, and psychologists are all licensed separately, and payers treat them differently.
Medicaid, HARPs, and Public Coverage in New York
Most New York Medicaid members are enrolled in Medicaid managed care plans, and behavioral health services have been integrated into those plans. Adults with serious mental illness or substance use disorders may instead be enrolled in a Health and Recovery Plan, or HARP, which covers additional behavioral health services. Claims for members who remain in fee-for-service Medicaid are processed through eMedNY. Child Health Plus covers many children, and the Essential Plan covers many lower-income adults who do not qualify for Medicaid, each through participating health plans. For a practice, that means confirming not only that a client has public coverage, but which program and which plan, before the first session.
Clinics licensed under Article 31 of the Mental Hygiene Law bill Medicaid under different rules than private group practices, so it matters which kind of practice you are. We set up billing for the structure you actually have.
The Empire Plan and Public Employee Coverage
The New York State Health Insurance Program covers state and many local government employees, mostly through the Empire Plan. Its mental health and substance use benefits are administered separately from its medical benefits, currently by Carelon Behavioral Health, so therapy claims for Empire Plan members go to a different place than the member’s medical claims. New York City employees have their own health benefits program as well. Verifying which program applies, and where behavioral health claims are sent, prevents one of the most common New York denials.
New York Prompt Payment Rules
New York’s prompt pay law, Insurance Law Section 3224-a, requires insurers and HMOs to pay undisputed claims within 30 days when they are submitted electronically and within 45 days when submitted on paper or by fax, and to deny or request more information within 30 days if a claim is disputed. Employer plans that self-insure under ERISA fall outside Section 3224-a, so those deadlines do not apply to them. We track which rules apply to each claim, so slow payments are followed up for the right reason.
Licensed Professions and What Payers Reimburse
New York licenses Licensed Mental Health Counselors, Licensed Marriage and Family Therapists, Licensed Creative Arts Therapists, and Licensed Psychoanalysts through the State Education Department, along with clinical social workers and psychologists. Not every payer credentials every one of these professions, and reimbursement can differ by license type. Before billing for a clinician, we confirm that each payer recognizes that license.
For clinical social workers, one long-standing New York detail changed recently. New York’s Insurance Law once tied insurers’ duty to cover an LCSW’s psychotherapy to the “R” privilege, which took three additional years of supervised experience. Effective January 1, 2023, that requirement was removed from the Insurance Law, and the state no longer issues new “R” privileges, although social workers who earned it keep the designation. Some payer directories and contracts still reflect the older rule, which is worth checking when an LCSW is credentialed.
Pre-Licensed Clinicians and Limited Permits
Many New York group practices employ clinicians who are completing their supervised experience, such as mental health counselor and marriage and family therapist applicants practicing under a limited permit, or Licensed Master Social Workers working under supervision. Payers vary widely in whether they credential these clinicians or reimburse their services, and billing a supervised clinician’s session under a supervisor’s name without meeting the payer’s conditions creates real compliance risk. We confirm each payer’s rules before those sessions are billed.
Telehealth and Clients Across State Lines
New York practices often see clients who commute from New Jersey or Connecticut, or who split time between New York and another state. A New York license generally covers a session only while the client is located in New York, and payer rules on place of service codes, modifiers, and audio-only sessions still vary by plan. Each payer’s telehealth policy is applied claim by claim, and any session where the client may have been outside New York is checked before it is billed.
Medicare and TRICARE in New York
Medicare claims in New York are processed by National Government Services, the Medicare Administrative Contractor for the region. Medicare opened to New York LMHCs and LMFTs on January 1, 2024, a real change for practices that had long referred older clients elsewhere. Military families in the North Country around Fort Drum, and elsewhere in the state, are covered under TRICARE East.
Credentialing for New York Behavioral Health Practices
With regional Blue plans, New York-based insurers, national carriers, Medicaid managed care plans, and HARPs, credentialing a New York clinician can mean a long list of separate applications, each with its own timeline and effective date. Until a network’s effective date arrives, sessions with its members are paid as out of network, if they are paid at all. We manage applications, CAQH, Medicaid enrollment, and follow-up for every clinician. Learn more about our behavioral health credentialing service. For the Medicaid side, see our New York Medicaid provider enrollment guide.
Common Reasons New York Behavioral Health Claims Deny
- The claim went to the wrong Blue plan. An Excellus or Highmark member billed as if the plan were Empire, or the reverse.
- Behavioral health is administered separately. An Empire Plan member’s therapy claim sent to the medical carrier instead of the mental health administrator.
- The public program or plan changed. A client who moved between Medicaid, a HARP, the Essential Plan, or a different managed care plan.
- The payer does not credential that license type. Especially relevant for creative arts therapists, psychoanalysts, and clinicians practicing under a limited permit.
- The telehealth client was in New Jersey or Connecticut. A New York license generally does not cover a client located in New Jersey or Connecticut.
For denials that have already happened, see our claims denial management service.
Serving Practices Across New York
New York practices look very different from one region to the next. Practices in the five boroughs and on Long Island see heavy Empire, EmblemHealth, Healthfirst, and Medicaid managed care volume. Westchester and the Hudson Valley often see more commuter coverage from New Jersey and Connecticut employers. Capital Region practices work with Highmark Blue Shield of Northeastern New York and MVP. Central New York and Rochester practices bill Excellus heavily, and Western New York practices bill Highmark BlueCross BlueShield of Western New York. We set up billing around the payers your region actually brings.
What Our New York Behavioral Health Billing Includes
- Verification of commercial, regional Blue, Empire Plan, Medicaid, HARP, Child Health Plus, Essential Plan, and Medicare coverage before the first session.
- Claims for every service your clinicians provide, from intake evaluations and individual psychotherapy to family, group, and psychiatric visits.
- Telehealth claims coded to each New York payer’s current policy.
- Appeals, corrected claims, and scheduled follow-up on anything unpaid.
- Credentialing and re-credentialing for every clinician and license type.
- A monthly view of what was collected, what is still open, and why claims were denied.
Counselors and therapy groups can read more on our therapy billing services page, and our behavioral health pages for New Jersey, Pennsylvania, Georgia, North Carolina, Illinois, Colorado, South Carolina, Connecticut, Missouri, Florida, and Texas cover those states.
Frequently Asked Questions
Do you bill Empire, Excellus, and Highmark plans?
Yes. We bill whichever regional Blue plan issued the client’s coverage, along with the other commercial and New York-based carriers.
Can you bill for Licensed Creative Arts Therapists and Licensed Psychoanalysts?
Where the payer recognizes the license, yes. We confirm each payer’s policy before billing.
Do LCSWs still need the “R” privilege to be reimbursed?
No. The requirement was removed from New York Insurance Law effective January 1, 2023, although some payer contracts and directories may still reference it.
Do you handle Medicaid managed care and HARP billing?
Yes, including Medicaid enrollment and credentialing with the plans your practice participates in.
Will you work in our EHR?
Yes. We bill from SimplePractice, TherapyNotes, Sessions Health, InSync, and other systems New York practices already use.
Let Us Handle Your New York Billing
If your practice is juggling regional Blue plans, the Empire Plan, Medicaid managed care, and a mix of license types, we can help. Talk with our team or call 800-820-0364 to see how we would handle your New York payer mix.