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Billing, marketing, staffing and software for Pennsylvania practices
RCM Finder supports medical practices in Pennsylvania remotely, with end to end revenue cycle management, healthcare digital marketing, virtual medical assistance and a practice management system. Below are the Medicare and Medicaid details that apply in Pennsylvania, with sources.
Our services in Pennsylvania
End to End RCM
Coding, billing, denials and payments, managed from patient visit to payment.
See the serviceGROWTHHealthcare Digital Marketing
Local search, ads and inquiry handling that help bring new patients to your practice.
See the serviceTEAMVirtual Medical Assistance
Remote assistants for scheduling, intake, prior authorization and follow-up.
See the serviceSOFTWAREPractice Management System
One system for scheduling, patient records and billing workflow.
See the servicePennsylvania billing details
Each row shows its source and when we checked it. If a source changes, we update the row.
| Topic | What applies in Pennsylvania | Source | Checked |
|---|---|---|---|
| Medicare contractor | Novitas Solutions (A/B MAC JL) | CMS, A/B MAC Jurisdiction JL | Oct 20, 2026 |
| Medicaid agency | Department of Human Services (DHS), Office of Medical Assistance Programs Medical Assistance (MA) program | Official provider page | Oct 20, 2026 |
| Provider enrollment and billing | Enrollment, manuals and billing guidance for Pennsylvania Medicaid providers | Open the provider page | Oct 20, 2026 |
| Medicaid fee schedule | Published fee schedules for Pennsylvania Medicaid | Open the fee schedule page | Oct 20, 2026 |
| Commercial prompt payment | Licensed insurers and managed care plans must pay clean claims, and the uncontested portion of a contested claim, within 45 days of receiving the claim from the health care provider. Interest owed on a late clean claim is added to the claim and paid within 30 days of the claim payment; interest under $2 per claim need not be paid. The rule applies only to claims under health insurance policies, not automobile or workers' compensation policies. 31 Pa. Code § 154.18 (Prompt payment), under the Health Care Accountability and Protection Act, Act 68 of 1998 (40 P.S. § 991.2101 et seq.) | pacodeandbulletin.gov | Oct 20, 2026 |
| Medicaid timely filing | Pennsylvania Medical Assistance must receive an original fee-for-service claim within 180 days after the date of service, except nursing facility and ICF/MR claims count from the last day of the billing period. | pa.gov | Oct 20, 2026 |
| Medicaid telehealth | MA Bulletin 99-23-08 (August 2, 2023) sets fee-for-service rules for physical health telehealth, including real-time two-way communication, payment at the in-person rate, and place-of-service codes 02 and 10, while managed care plans set their own coverage. | pa.gov | Oct 20, 2026 |
Major cities in Pennsylvania
We support practices in these cities and everywhere else in Pennsylvania, remotely.
Remote by design
No office visit needed
We support practices in every state remotely, so you do not need a local office to work with us.
Rules checked for your state
Each state page lists the Medicare contractor and Medicaid details for that state, with sources and the date we last checked.
One service or all four
Begin where the gap is biggest, whether that is payments, new patients, front-desk capacity or your software.
Pennsylvania practice questions
Who processes Medicare claims in Pennsylvania?
Novitas Solutions is the Medicare Administrative Contractor (MAC) that processes Part A and Part B claims in Pennsylvania (A/B MAC JL), according to CMS.
Which agency runs Medicaid in Pennsylvania?
Department of Human Services (DHS), Office of Medical Assistance Programs runs Medicaid in Pennsylvania (the Medical Assistance (MA) program). The official state pages linked in the table above cover provider enrollment and billing.
How quickly must insurers pay a clean claim in Pennsylvania?
Licensed insurers and managed care plans must pay clean claims, and the uncontested portion of a contested claim, within 45 days of receiving the claim from the health care provider. Interest owed on a late clean claim is added to the claim and paid within 30 days of the claim payment; interest under $2 per claim need not be paid. The rule applies only to claims under health insurance policies, not automobile or workers' compensation policies.
How long do I have to file a Medicaid claim in Pennsylvania?
Pennsylvania Medical Assistance must receive an original fee-for-service claim within 180 days after the date of service, except nursing facility and ICF/MR claims count from the last day of the billing period.
Do you work with practices outside the largest cities in Pennsylvania?
Yes. We work remotely, so a practice in a small town is supported the same way as a practice in Philadelphia.
Which service should a practice in Pennsylvania start with?
Start where the problem is biggest: End to End RCM if payments are slow or denials are high, Healthcare Digital Marketing if your schedule has gaps, Virtual Medical Assistance if your front desk is stretched, or a Practice Management System if your tools are scattered. Tell us about your practice and we will suggest a first step.
What should I send first?
A short description of your practice, your specialty, your main payers and the biggest problem you want fixed. Our form asks for the basics.
Ask about your Pennsylvania practice
We will reply with the details that apply to Pennsylvania and a suggested first step.