Pennsylvania Medicaid — Pennsylvania Medical Assistance (HealthChoices)
| Program name | Pennsylvania Medical Assistance (HealthChoices) |
|---|---|
| Provider portal | https://www.dhs.pa.gov/providers |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 180 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Pennsylvania Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Pennsylvania
The Blue Cross Blue Shield Association licensee in Pennsylvania is Independence Blue Cross (Philadelphia region) / Highmark BCBS (West). See the Independence Blue Cross payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in Pennsylvania
The dominant commercial insurers operating in Pennsylvania, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Pennsylvania
Pennsylvania Medical Assistance (HealthChoices) contracts with the following managed-care organizations to administer Medicaid benefits in Pennsylvania. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
State-specific regulations affecting Pennsylvania billing
- PA Act 146 of 2020 (Surprise Balance Billing protections)
- 40 P.S. §991.2166 / Act 68 (prompt pay and claim disputes for HMOs)
- PA Act 6 of 1993 / HMO prompt payment — 45 days clean claim
Provider licensing & enrollment in Pennsylvania
Providers enroll with PA MA via PROMISe Provider Portal. Each HealthChoices MCO contracts separately. PA requires MA enrollment to bill any HealthChoices MCO.
Major health systems headquartered in Pennsylvania
| Health system | Headquarters |
|---|---|
| UPMC | Pittsburgh, PA |
| Penn Medicine (University of Pennsylvania Health System) | Philadelphia, PA |
| Geisinger | Danville, PA |
| Jefferson Health | Philadelphia, PA |
| Main Line Health | Radnor, PA |
Frequently asked questions — Pennsylvania billing
What is the Pennsylvania Medicaid program called?
Pennsylvania's Medicaid program is known as Pennsylvania Medical Assistance (HealthChoices). Providers enroll and manage claims through the provider portal at https://www.dhs.pa.gov/providers.
What is the Pennsylvania Medicaid timely filing limit?
Pennsylvania Medical Assistance (HealthChoices) requires initial claims to be filed within 180 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Pennsylvania's 180-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Pennsylvania Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Pennsylvania Medical Assistance (HealthChoices). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Pennsylvania?
The dominant commercial payers in Pennsylvania include Independence Blue Cross, Highmark BCBS, UnitedHealthcare, Aetna, Cigna, along with the BCBS licensee Independence Blue Cross (Philadelphia region) / Highmark BCBS (West). Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Pennsylvania?
Pennsylvania Medical Assistance (HealthChoices) contracts with 2 Medicaid MCOs tracked in the QuickIntell registry, including UnitedHealthcare, Aetna. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Pennsylvania?
Pennsylvania has 3 tracked state-level statutes that affect medical billing and RCM: PA Act 146 of 2020 (Surprise Balance Billing protections); 40 P.S. §991.2166 / Act 68 (prompt pay and claim disputes for HMOs); PA Act 6 of 1993 / HMO prompt payment — 45 days clean claim. These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Pennsylvania with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Pennsylvania Medical Assistance (HealthChoices) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Pennsylvania Medicaid and the member ID card before submission.