Pennsylvania practices bill Medicare through Novitas, Medical Assistance through HealthChoices managed care and PROMISe, and a commercial market split between Independence Blue Cross, Highmark, UPMC Health Plan and Capital Blue Cross depending on the region.
How Medical Billing Works in Pennsylvania
Every state has its own mix of payers and rules, and Pennsylvania is no exception. These are the points that most often decide whether a Pennsylvania claim is paid on the first pass:
- Pennsylvania's commercial market is regional: Independence Blue Cross dominates around Philadelphia, Highmark and UPMC Health Plan in the west, and Capital Blue Cross in the Harrisburg area — each with its own edits and portals.
- Most Medical Assistance members are enrolled in HealthChoices managed care, so we verify the assigned physical-health plan before billing rather than defaulting to PROMISe fee-for-service.
- Medicare Part B claims go to Novitas Solutions (Jurisdiction L), with separate payment localities for the Philadelphia area and the rest of the state.
Our Medical Billing Services in Pennsylvania
We run the complete revenue cycle for Pennsylvania practices, remotely and inside your existing EHR or practice management system:
- Insurance eligibility and benefits verification before each visit
- Medical coding (CPT, ICD-10-CM, HCPCS and modifiers) by certified coders
- Charge entry and claim scrubbing to catch errors before submission
- Electronic claim submission to Medicare, Pennsylvania Medical Assistance plans and commercial payers
- Denial management and appeals with root-cause tracking
- A/R follow-up on aging claims, worked daily
- Payment posting from ERAs and EOBs, including underpayment checks
- Credentialing and payer enrollment, including PROMISe provider enrollment
- Monthly reporting on collections, denials and days in A/R
Who We Work With
Our Pennsylvania clients include primary care and internal medicine practices, specialty groups such as clinical billing, gastroenterology billing and endocrinology billing, independent laboratories and multi-location clinics. Whether you are in Philadelphia, Pittsburgh or a smaller community, you get the same certified coders, the same daily A/R follow-up and the same transparent reporting.
Cities We Serve in Pennsylvania
Specialties We Bill For in Pennsylvania
Frequently Asked Questions
Who processes Medicare claims in Pennsylvania?
Medicare Part B claims for Pennsylvania are processed by Novitas Solutions (Jurisdiction L (JL)). We submit, track and follow up on those claims for you, including Medicare Advantage plans, which are billed to the private plan instead.
How do you bill Pennsylvania Medical Assistance?
Pennsylvania Medical Assistance is run by the Department of Human Services (DHS) through the PROMISe system, and most members are enrolled in HealthChoices managed care plans. We verify the member's plan before the visit and send each claim to the right plan with the right edits.
Which commercial payers do you work with in Pennsylvania?
We bill all major commercial payers in Pennsylvania, including Highmark Blue Cross Blue Shield, Independence Blue Cross, Capital Blue Cross, UPMC Health Plan and Geisinger Health Plan, plus regional and employer plans.
Which Pennsylvania cities do you serve?
We serve practices throughout Pennsylvania, with dedicated pages for Philadelphia, Pittsburgh, Allentown, Reading, Erie, Scranton, Bethlehem, Lancaster, Harrisburg and York. Because billing is done remotely, practices anywhere in the state can work with us.
How do we get started?
Request a free billing audit. We review a sample of your claims, denials and A/R, show you where revenue is being lost and give you a fixed quote — with no obligation.