Practices in Philadelphia, PA use The Medical Billing to get claims paid correctly the first time. We code, submit and follow up on every claim for physicians, clinics and labs throughout Philadelphia County, and we report back on exactly where your money is.
Medical Billing for Philadelphia's Healthcare Market
With major providers like Penn Medicine, Jefferson Health, Temple Health and Children's Hospital of Philadelphia in the area, Philadelphia has a competitive healthcare market where patients often see several providers. Clean documentation, correct referring-provider information and timely authorizations make the difference between a paid claim and a denial — and that is where our team focuses.
Pennsylvania Payer Rules We Handle for Philadelphia Practices
- Medicare: Part B claims go to Novitas Solutions; Medicare Advantage claims go to the patient's private plan with its own authorization rules.
- Medicaid: Pennsylvania Medical Assistance is run by the Department of Human Services (DHS) through the PROMISe system, and most members are in HealthChoices managed care plans.
- Commercial plans: we bill Highmark Blue Cross Blue Shield, Independence Blue Cross, Capital Blue Cross and UPMC Health Plan and the employer plans common in Philadelphia County.
- Local detail: 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.
What's Included for Philadelphia Practices
- 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
Why Philadelphia Practices Outsource Billing to Us
Billing staff are hard to hire and harder to keep. Outsourcing gives your Philadelphia practice a full team — coders, billers and A/R specialists — for a predictable cost, with coverage during vacations and turnover. You get monthly reports on collections, denial rates and days in A/R, so you always know how the practice is performing.
We also support practices in Upper Darby, Cheltenham, Bensalem and King of Prussia, and across the rest of the state — see our Pennsylvania medical billing services or nearby pages for Allentown and Reading. Specialty groups can read more about our endocrinology billing and laboratory billing services.
Specialties We Bill For in Philadelphia
Frequently Asked Questions
Do you provide medical billing services in Philadelphia, PA?
Yes. We work remotely with physician practices, clinics, specialty groups and labs in Philadelphia and across Philadelphia County. We handle coding, claims, denials and A/R follow-up for Medicare, Pennsylvania Medical Assistance and commercial payers.
Which insurance payers do you bill for Philadelphia practices?
Medicare Part B through Novitas Solutions, Medicare Advantage plans, Pennsylvania Medical Assistance and its managed care plans, and commercial payers such as Highmark Blue Cross Blue Shield, Independence Blue Cross and Capital Blue Cross.
Do you work with practices near Philadelphia?
Yes — including Upper Darby, Cheltenham, Bensalem and King of Prussia. Billing is done remotely, so practices anywhere in Pennsylvania can work with us.
How much does medical billing cost for a Philadelphia practice?
Most billing companies charge a percentage of monthly collections, commonly between 4% and 10% depending on specialty and claim volume. We give you a fixed quote after a free audit of your claims and A/R.
How long does it take to switch to your billing service?
It depends on how quickly payer and EHR access can be set up. We plan the transition so that existing A/R keeps being worked while new claims move to our team, and we share a timeline after the free audit.