Medical Billing Services in Pennsylvania
Medical billing for Pennsylvania practices that bill Medical Assistance, HealthChoices managed care plans, Medicare and commercial payers.
Billing support for Pennsylvania practices
Pennsylvania's Medicaid program, called Medical Assistance, is billed through the PROMISe system, and most members are enrolled in HealthChoices managed care plans. Commercial billing is shaped by large regional payers such as Highmark, Independence Blue Cross and UPMC Health Plan, each with its own rules.
We handle that billing remotely. Our team verifies coverage before the visit, submits clean claims inside each payer's window, works every denial and follows up on aging balances, so your staff can focus on patients.
We support practices across Pennsylvania, including Philadelphia, Pittsburgh, Allentown, Harrisburg, Erie and Scranton. Learn more about our medical billing, denial management, claims processing and revenue cycle management services.
What we handle for Pennsylvania practices
- Medicare Part B claims through Novitas Solutions, the Medicare contractor for Pennsylvania (Jurisdiction L)
- Medical Assistance fee-for-service claims through PROMISe
- HealthChoices managed care plan claims and authorizations
- Tracking of the 180-day original claim limit and 365-day adjustment window
- Commercial payers such as Highmark, Independence Blue Cross and UPMC Health Plan
- Monthly reports on collections, denials and days in A/R
Pennsylvania billing rules at a glance
The payer rules that shape how Pennsylvania claims get paid. Plan contracts can differ, so we confirm each payer's current requirements during onboarding.
Medicaid program
Medical Assistance, billed through PROMISe, plus HealthChoices managed care plans
Medicaid filing limit
Original claims within 180 days of the date of service; adjustments and voids within 365 days
Medicare contractor (Part A/B)
Novitas Solutions (Jurisdiction L)
Major commercial payers
Highmark, Independence Blue Cross, UPMC Health Plan, Capital Blue Cross, Geisinger Health Plan, Aetna and UnitedHealthcare
Common Pennsylvania denials and how we prevent them
Past the 180-day limit
Medical Assistance claims received after 180 days are denied unless an exception applies. We submit promptly and track every claim against the deadline.
Wrong plan or network
Patients move between Medical Assistance and HealthChoices plans and between regional commercial networks. We confirm the responsible plan before the visit.
Authorization and referral gaps
Managed care plans often need referrals or prior authorization. We request and track them before the service.
Specialties we bill for in Pennsylvania
Frequently Asked Questions
What is the Pennsylvania Medical Assistance timely filing limit?
Original Medical Assistance claims must be received within 180 days of the date of service. Adjustments and voids must be submitted within 365 days.
Do you bill HealthChoices managed care plans?
Yes. We bill Medical Assistance fee-for-service through PROMISe and the HealthChoices managed care plans, following each plan's authorization and filing rules.
Who is the Medicare contractor for Pennsylvania?
Novitas Solutions processes Medicare Part A and Part B claims for Pennsylvania as the Jurisdiction L Medicare Administrative Contractor.
Do you work with practices in both Philadelphia and Pittsburgh?
Yes. We work remotely through secure access to your systems, so practices anywhere in Pennsylvania work with us the same way.
How much does medical billing cost for a Pennsylvania practice?
We charge a percentage of the payments we successfully collect, with no upfront or setup fees. The percentage depends on your specialty and claim volume, so we quote it after a free review.
Other states we serve
Ready to Get Paid Faster?
Get a free billing review. We'll look at your current collections, denials and A/R and show you where revenue is being lost.