Submit a Medicaid claim

If you have health insurance through Medicaid and have received a hospital bill, we can help you by submitting a claim for you.

In the state of New York, all claims to Medicaid must be submitted within two years of the date of treatment.

Please provide the following information so that we can submit your insurance claim:

* indicates a required field

Patient information


Insurance information


Employer information

Contact information


* indicates a required field

Patient information

Medicaid information

If you have Medicaid in a State other than New York, please provide the following information:

Medicaid Information Out of State

Carrier information

Contact information

(888) 214-4065

Call for help

For help submitting an insurance claim, call the Financial Assistance Unit.

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