Claims and Billing
As required by the Affordable Care Act and implementing regulation, all practitioners, including those who order, refer, or prescribe items or services for Pennsylvania Medical Assistance (MA) beneficiaries, must enroll in the Pennsylvania MA program.
Claims will be denied if ordering, referring, or prescribing provider is not enrolled in the MA program.
Learn about our claims address, electronic payer IDs, provider dispute information, provider appeals, and more.
- View our billing information
- Direct claim entry for small to medium practices
- Electronic claims submission, payment, and remittance advice services
- Claims filing guide for HCBS providers (PDF)
- Claims filing guide for medical providers (PDF)
- June 1, 2020, new and current explanation of benefit (EOB) codes (PDF)
- Eligibility verification guide (PDF)
- Supplemental billing information for modifiers 25 and 59 (PDF)
Additional billing information
- Claims project submission form (PDF)
- False Claims Act information (PDF)
- Fraud, waste, and abuse information
- Medical Assistance fee schedules
- Nursing facility billing guide (PDF)
- Observational billing guide (PDF)
- Participant copay schedule (PDF)
- Policy for billing medical assistance recipients for missed appointments (PDF)
- Rejected and corrected claims rules (PDF)