Medical Billing Services in Pennsylvania
Pennsylvania is our home state — ImmediCare Solutions is based in Philadelphia, and we know this payer map street by street. It's a genuinely unusual one: Pennsylvania is carved into regional payer kingdoms, with Independence Blue Cross ruling the southeast, Highmark the west and center, UPMC Health Plan and Highmark in open competition around Pittsburgh, and Geisinger anchoring the northeast. Medical Assistance gives providers 180 days to file, with most members in HealthChoices managed care zones, and Act 68 puts a 45-day clean-claim clock on commercial payers. If your practice is anywhere from Philly to Erie, you're in our backyard.
Medical Assistance (MA): filing rules that decide whether you get paid
Administered by the PA Department of Human Services (DHS)
Pennsylvania Medical Assistance fee-for-service claims must be filed within 180 days of the date of service through the PROMISe system, which also handles provider enrollment and revalidation. Physical-health managed care runs through HealthChoices zones with MCOs including AmeriHealth Caritas (a Philadelphia-headquartered national Medicaid player), UPMC for You, Geisinger Health Plan, Highmark Wholecare and UnitedHealthcare Community Plan — each zone has its own plan lineup, and long-term services run separately under Community HealthChoices. Behavioral health is carved out to county-based BH-MCOs, a structure that regularly trips up out-of-state billers.
Deadlines for every major payer — including Pennsylvania Medicaid — live in our timely filing limits tool, with an interactive deadline checker.
The payers we bill every day in Pennsylvania
Pennsylvania billing rules that move real money
Act 68 prompt pay
Pennsylvania's Act 68 of 1998 requires licensed insurers and managed care plans to pay clean claims within 45 days, with 10% annual interest owed on late payments. The PA Insurance Department accepts provider prompt-pay complaints and has fined carriers for systemic lateness — a lever most practices never pull.
Behavioral health carve-out
Pennsylvania routes Medicaid behavioral health through county-contracted BH-MCOs (like Community Behavioral Health in Philadelphia) entirely separate from the physical-health plans. Billing BH services to the physical-health MCO is one of the most common denial sources we see from practices new to PA Medicaid.
Where we work in Pennsylvania
We support practices across the state remotely — same-day claim submission and a dedicated team regardless of your zip code. The markets we serve most:
Credentialing & enrollment in Pennsylvania
Physician licensing in Pennsylvania runs through the Pennsylvania State Board of Medicine, and payer enrollment is its own workstream on top of it — state Medicaid enrollment, CAQH upkeep, and individual plan contracting each on their own timeline. Our credentialing service manages the full stack for Pennsylvania providers, and our credentialing calculator estimates realistic timelines by payer.
Pennsylvania billing FAQs
What is the timely filing limit for Pennsylvania Medical Assistance?
180 days from the date of service for fee-for-service claims through PROMISe. HealthChoices MCOs set their own limits — commonly 180 days, but verify per plan. Documented exceptions can extend eligibility for payment in limited cases.
Is ImmediCare Solutions actually based in Pennsylvania?
Yes — we're headquartered in Philadelphia. Pennsylvania is our home market, and we work with practices across the state, from IBX territory in the southeast to the UPMC–Highmark market in the west.
How does the behavioral health carve-out affect my billing?
PA Medicaid behavioral health claims go to county-based BH-MCOs, not the member's physical-health plan. Each county contract has its own payer, auth rules and rates — we route claims to the correct BH-MCO by county of member residence.
What does Act 68 require of Pennsylvania insurers?
Clean claims must be paid within 45 days, with 10% annual interest on late payments. We track payer turnaround against the Act 68 clock and escalate chronic offenders to the PA Insurance Department when warranted.
Medical billing services in other states
Ready to stop losing revenue in Pennsylvania?
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