New York E-Billing Requirements for Healthcare Providers

This document is a guide detailing the new e-billing requirements for healthcare providers in New York, effective August 1, 2025. It outlines the necessity for all healthcare providers to submit CMS-1500 medical bills electronically through a board-approved electronic submission partner. The guide emphasizes the importance of preparing billing systems and teams for this transition to avoid denials and streamline reimbursements. It provides additional guidance for payers, specifying that paper bills should not include form C-8.1B (Notice of Objection). Instead, payers are instructed to send an Explanation of Benefits (EOB) indicating that payment is denied due to non-electronic submission, along with a request for the provider to resubmit the bill electronically within a 120-day timeframe. Resources such as the NY CMS-1500 E-Billing Guide and FAQs are also mentioned for further assistance.