Pennsylvania's healthcare market is regional: Highmark and UPMC dominate the west, Independence Blue Cross the Philadelphia area, and Capital Blue Cross and Geisinger the central part of the state. Each region has its own payer rules.
Medical Coder provides outsourced medical billing services in Pennsylvania for independent practices, clinics and groups. We handle the full revenue cycle — eligibility, coding, claims, denials and A/R — with Pennsylvania payer rules built into every step.
Pennsylvania Payers We Bill Every Day
- Medicaid: Pennsylvania Medical Assistance, administered by the Department of Human Services (DHS), through HealthChoices physical health plans such as UPMC for You, Keystone First, AmeriHealth Caritas Pennsylvania and Highmark Wholecare.
- Medicare: Part A and Part B claims through Novitas Solutions (Jurisdiction L), plus Medicare Advantage plans.
- Commercial plans: Highmark Blue Cross Blue Shield, Independence Blue Cross, Capital Blue Cross, UPMC Health Plan, Geisinger Health Plan, Aetna and UnitedHealthcare.
- TRICARE and VA Community Care for military families and veterans.
What Makes Medical Billing in Pennsylvania Different
Pennsylvania's Medicaid program separates physical and behavioral health: behavioral health services are billed to a county behavioral health managed care organization, not the physical health plan on the patient's card. Billing the wrong entity is a common and avoidable denial — especially for practices that offer both kinds of care.
Our Medical Billing Services for Pennsylvania Practices
- Eligibility and benefits verification before every visit
- Certified ICD-10, CPT and HCPCS coding with modifier review
- Charge entry and claim scrubbing before submission
- Electronic claim submission and payment posting
- Denial management and appeals
- A/R follow-up on every unpaid claim, including aged A/R
- Patient statements and balance support
- Provider credentialing and payer enrollment
- Monthly reporting on collections, denials and days in A/R
Medical Billing Across Pennsylvania's Major Cities
We work with practices statewide, with dedicated support for Philadelphia, Pittsburgh, Allentown, Reading, Erie, Scranton, Bethlehem, Lancaster, Harrisburg, York. Choose your city below for local details.
Why Pennsylvania Practices Choose Medical Coder
- Pennsylvania payer expertise — Medicaid managed care, Novitas Solutions Medicare rules and the state's major commercial plans.
- Certified coders across 45+ specialties — see all specialties.
- Structured denial management with root-cause fixes.
- Transparent pricing — see how medical billing pricing works.
Get a Free Billing Audit for Your Pennsylvania Practice
We will review your claims, denials and A/R at no cost and show you exactly where revenue is being lost. Start with a free medical billing audit or see medical billing for small practices.