Advanced Medical billing services in Pennsylvania
SwiftCare Billing offers medical billing services in Pennsylvania for practices tired of chasing payers. We bill Pennsylvania Medical Assistance (Medicaid), Novitas Solutions for Medicare, and carriers like Highmark. Pricing starts at 3% of collections. Month-to-month, 30 days’ notice.
- 98.4% Clean Claim Rate
- 175+ Providers
- 50+ Specialties
- 12+ Years
Pennsylvania at a glance: payers, deadlines and rules
| Item | Pennsylvania |
|---|---|
| Medicaid program | Medical Assistance, run by the Department of Human Services (DHS) |
| Medicaid enrollment | HealthChoices alone covers more than 2.6 million people |
| Physical health plans | AmeriHealth Caritas PA, Geisinger Health Plan, Health Partners Plans, Highmark Wholecare, Keystone First, UnitedHealthcare Community Plan, UPMC for You (which ones depend on the zone) |
| Long-term care and dual-eligible plans | Community HealthChoices: UPMC CHC, AmeriHealth Caritas/Keystone First CHC, PA Health & Wellness CHC |
| Provider portal | PROMISe |
| Medicare A/B contractor | Novitas Solutions, Jurisdiction L (also DE, DC, MD, NJ) |
| Medicare DME contractor | DME MAC Jurisdiction A |
| Medicare timely filing | 12 months from date of service |
| Medical Assistance fee-for-service filing | 180 days from date of service; exception requests have their own 60-day window |
| Commercial prompt pay | 45 days for clean claims, with 10% interest (Act 68) |
| Surprise billing | Federal No Surprises Act, with the Insurance Department as state lead |
| Auto accident claims | Act 6 of 1990: Medicare-based payment limits, no balance billing |
| Workers' compensation | Capped at 113% of Medicare for outpatient care |
What makes Pennsylvania claims different?
Seven Medicaid plans, and the zone decides which one.
Pennsylvania splits HealthChoices into five zones: Southeast, Southwest, Lehigh/Capital, Northeast, and Northwest. A patient in Erie may have a different plan menu than one in Allentown. Plans also carry separate prior authorization lists. A claim sent to the wrong plan gets denied. We confirm the plan on the date of service.
The Community HealthChoices re-bid collapsed in April 2026
A Commonwealth Court ruling on April 2, 2026, struck down DHS’s selection of CHC plans and ordered the process restarted. The three current plans stay in place for now, and patient coverage isn’t affected. For billing offices, that means more network uncertainty ahead. We track plan notices so your contracts don’t lapse quietly.
Auto claims run on Medicare rates, and you can’t bill the patient the rest.
Under Act 6, auto insurers pay providers using the Medicare fee schedule, and providers generally can’t chase patients for the difference. Billed charges above the cap just disappear. We code and bill auto claims to those limits from the start, so you aren’t writing off surprises later.
Work comp tops out at 113% of Medicare.
The Bureau of Workers’ Compensation caps outpatient fees at 113% of Medicare and bars balance billing. Its Part B schedule was updated in August 2026. We check each work injury claim against the current schedule.
- Our Services
Medical billing services in Pennsylvania, step by step
Our medical billing service in Pennsylvania covers the whole revenue cycle, or any single step. That includes medical billing and coding services in Pennsylvania from AAPC-certified coders.
We confirm Medical Assistance versus a HealthChoices plan versus CHC before the visit
Codes checked against Novitas edits and each plan’s rules
Claim submission
Claims scrubbed, then followed to payment
Denials logged by payer and reason, then fixed at the source
Claims past day 45 get chased for payment and interest
Payments posted; statements in plain English
Requests tracked plan by plan
Outsourced medical billing services in Pennsylvania
You send us the encounters, and we do the rest. Eligibility, coding, submission, denials, and follow-up sit with one team. You get one named account manager and a monthly report.
Medical billing solutions for healthcare providers in Pennsylvania
Some practices hand us everything. Others only want denials worked or old A/R cleaned up. Either works, and you can add services later.
Getting enrolled and credentialed in Pennsylvania
No enrollment, no payment. Medical Assistance providers enroll through PROMISe, and each HealthChoices plan then credentials you separately. Our medical credentialing services cover every layer.
- NPI check and an attested CAQH profile
- Medicare enrollment through PECOS, processed by Novitas
- Medical Assistance enrollment in PROMISe
- Credentialing with each HealthChoices and CHC plan you choose
- Commercial plan applications
- Revalidation reminders
Who pays your claims in Pennsylvania?
We bill Medicare, Medicare Advantage, Medical Assistance plans, and commercial carriers such as Highmark, UPMC Health Plan, Capital Blue Cross, and Geisinger. Practices in the Philadelphia area can also see our Philadelphia billing page.
Where each claim goes:
| Patient’s coverage | Who gets the claim | Rule to watch |
|---|---|---|
| Medical Assistance, fee-for-service | DHS, through PROMISe | 180 days from service |
| HealthChoices | The patient’s plan | The plan’s own filing limit |
| Community HealthChoices | The patient’s CHC plan | The plan’s own filing limit |
| Medicare | Novitas | 12 months |
| Commercial | The carrier | 45 days to pay, 10% interest |
| Auto accident | Auto insurer | Medicare-based cap (Act 6) |
| Workers’ comp | WC carrier | 113% of Medicare |
Searching for the best medical billing services in Pennsylvania? Ask each vendor how they handle the rules above. Here’s how to compare medical billing companies in Pennsylvania.
Specialties we support across Pennsylvania
We bill 50+ specialties. Pennsylvania practices often come to us in family practice, pediatrics, mental health, physical therapy, chiropractic, and cardiology. Practices with auto and work injury patients gain the most from Act 6 and fee-schedule experience.
Works with the EHR you already have
We support 80+ systems and work inside yours: Epic, athenahealth, eClinicalWorks, Tebra (Kareo), and AdvancedMD are a few. Nothing to migrate. We connect to your clearinghouse and PROMISe.
Serving practices from Pittsburgh to Philadelphia
Pittsburgh, Philadelphia, Harrisburg, Allentown, Erie, Scranton, Lancaster, Reading, Bethlehem, and State College, plus the rural counties in between. Our office in Marlton, New Jersey, is a short drive from Philadelphia. SwiftCare Billing serves providers in all 50 states. See all states
Why Pennsylvania practices work with SwiftCare Billing
- Cleaner claims. Our clean claim rate is 98.4%.
- Certified staff. 200+ certified billers and AAPC-certified coders, all U.S.-based.
- A person, not a queue. Every practice gets a named account manager.
- Straight pricing. From 3% of collections, with no long-term contract.
- Reports you can read. Monthly numbers on collections, denials, and A/R.
- No software change. We use your EHR.
- Fast start. Go-live in 7 to 14 business days.
Privacy and HIPAA, in plain terms
You’re trusting us with patient records, so we start with paperwork. A business associate agreement comes first, because HIPAA requires it (45 CFR 164.504(e)). If a breach ever happens, we have to tell you without unreasonable delay, and no later than 60 days after we find it (45 CFR 164.410). Your agreement may set a shorter clock.
Our staff sees only what each billing task needs. And your data remains yours if you leave.
Numbers you can check
98.4% clean claim rate across SwiftCare Billing clients
Onboarding in 7 to 14 business days
Free audit report in 5 business days
Medical billing services for small practices in Pennsylvania: what it costs
Pricing starts at 3% of collections. Most practices pay 3% to 8%, based on specialty, claim volume, and payer mix. A small practice with a few providers usually lands toward the lower end if the payer mix is clean. There’s no long-term contract. See pricing.
Your first 14 days
1. Send us recent claims; we return a written audit in 5 business days.
2. Give us access to your EHR and clearinghouse.
3. We check your enrollment with Novitas, PROMISe, and each plan.
4. We review your fee schedules and contracts.
5. You go live in 7 to 14 business days, and reports start the next month.
Ready to Turn Your Revenue
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Common questions about Pennsylvania medical billing
How much do medical billing services cost in Pennsylvania?
Pricing starts at 3% of collections. Most practices pay 3% to 8%. A free audit gives you a quote based on your own claims.
Which Pennsylvania Medicaid plans do you bill?
HealthChoices plans such as AmeriHealth Caritas, Geisinger, Health Partners, Highmark Wholecare, Keystone First, UnitedHealthcare, and UPMC for You, plus CHC plans. Which ones apply depends on your county.
Who processes Medicare claims in Pennsylvania?
Novitas Solutions, as the A/B MAC for Jurisdiction L. DME claims go to DME MAC Jurisdiction A. Medicare claims must be filed within 12 months.
How long do I have to file a Medical Assistance claim?
Fee-for-service claims must reach DHS within 180 days of the date of service. Exceptions exist, but you must request one within 60 days of the triggering event, like a third-party denial.
How fast must Pennsylvania insurers pay?
Under Act 68, managed care plans and insurers must pay clean claims within 45 days or owe 10% interest. Self-funded employer plans follow federal law.
Can you bill auto accident claims under Act 6?
Yes. Act 6 limits payment using Medicare rates and generally blocks billing the patient the difference. We build claims to those limits.
Do you bill workers’ compensation?
Yes. Outpatient care is capped at 113% of Medicare, and providers can’t balance bill the worker.
Can you work inside our EHR?
Yes. We support 80+ systems, and you keep yours.
Get a second opinion on your Pennsylvania billing.
Tell us which HealthChoices plans and commercial payers you bill. We’ll review your recent claims and send a written report within 5 business days.