Medical Billing Services in Pennsylvania
Pennsylvania practices bill Novitas for Medicare Part A and B, DHS and HealthChoices plans for Medical Assistance, and a commercial market split by region. We help keep all of it organized. We support practices in Pennsylvania remotely across 15+ specialties.
Who Pays Medical Claims in Pennsylvania
The payer groups our team works with every day for Pennsylvania practices.
Jurisdiction JL
Pennsylvania Medicare Part A and Part B claims go to Novitas Solutions, Inc.. Medicare DME claims go to DME MAC Jurisdiction A (Noridian Healthcare Solutions).
Pennsylvania Medical Assistance (Medicaid)
Run by the Department of Human Services (DHS), with fee-for-service claims processed in PROMISe.
Managed care plans
Most Medical Assistance members are enrolled in HealthChoices managed care: Physical HealthChoices plans, Community HealthChoices for long-term services and supports, and Behavioral HealthChoices for mental health and substance use services. We bill and follow up with the state’s Medicaid managed care plans under each plan’s own rules.
Plan lists change. We confirm each patient's current plan at eligibility check. Commercial and Medicare Advantage plans are billed under their own contracts.
Pennsylvania Medicaid Billing Rules to Know
Taken from the state program's published provider guidance. Manuals change, so we confirm current rules before each submission.
180-day filing limit
Original claims must be received by DHS within 180 days after the date of service.
365-day resubmission
A rejected original claim can be resubmitted, but it must be received within 365 days of the date of service.
Late-claim exceptions
Claims past the limit are rejected unless they qualify for an exception, such as a delayed eligibility determination or third-party payment, requested within the required 60-day period with supporting documents.
Source: 55 Pa. Code § 1101.68, Invoicing for services; PA DHS FAQ – Billing and Claims.
What Makes Pennsylvania Medical Billing Different
What we watch for on Pennsylvania accounts.
Why Pennsylvania billing gets complicated
Behavioral health services for Medical Assistance members are often carved out to Behavioral HealthChoices, so the physical health plan on the card may not be the payer for a therapy visit. The commercial market is also regional, with different Blue plans in the east, center and west of the state. We check which payer owns the benefit during eligibility verification, before the first session.
What We Handle for Pennsylvania Practices
Take the full revenue cycle or just the parts you need help with.
Eligibility and benefits checks before the visit
Prior authorization requests and tracking
Medical coding and charge review
Claim submission to Medicare, Medicaid and commercial payers
Denial management, appeals and A/R follow-up
Payment posting, patient statements and monthly reporting
Specialties We Support in Pennsylvania
15+ specialties served. Pick yours to see how we bill it.
Pennsylvania Medical Billing Questions
Short answers to questions we hear from practices.
Who processes Medicare Part A and B claims in Pennsylvania?
Pennsylvania is in A/B MAC Jurisdiction L (JL), administered by Novitas Solutions. Medicare DME claims go to the Jurisdiction A DME MAC, Noridian Healthcare Solutions.
What is the Pennsylvania Medical Assistance timely filing limit?
Under 55 Pa. Code § 1101.68, original claims must be received within 180 days after the date of service. Rejected claims can be resubmitted within 365 days of the date of service.
Who pays for behavioral health services for Medical Assistance members?
Usually the member's Behavioral HealthChoices plan, not the physical health plan. We confirm the right payer before the claim goes out.
Which specialties do you support in Pennsylvania?
We support 15+ specialties, including behavioral health, laboratory, home health, hospice, infusion, sleep medicine, DME, dental, vision and ENT.
Can Salyx RCM support my Pennsylvania practice remotely?
Yes. We support practices in Pennsylvania remotely, working inside your billing system with secure access.
See Where Your Pennsylvania Claims Are Getting Stuck
Start with a free billing audit. We review your recent claims, denials and A/R, then tell you what we found.