Expert Revenue Cycle Management in Pennsylvania
Mediknocx manages the full revenue cycle for independent practices and physician groups across Pennsylvania. The state has three Blue Cross Blue Shield licensees: Highmark, the only statewide Blue Shield licensee, Independence Blue Cross in the Philadelphia region, and Capital Blue Cross in central Pennsylvania. Which Blue plan a patient carries depends on where they live, and Medicaid adds a second layer of routing on top.
HIPAA Compliant
Your data stays secure
Faster Payments & Fewer Denials
Improve cash flow
Higher Reimbursement
Get the revenue you deserve
Pennsylvania Billing Compliance Experts
State-specific payer knowledge
Get Your Free Revenue Assessment
Find out how much revenue your practice could be recovering with expert revenue cycle management support. No obligation, just real insights.
Expert Revenue Cycle Management in Pennsylvania: Where the Patient Lives Decides Who Pays
Pennsylvania Medical Assistance carves behavioral health out of its managed care plans in all 67 counties. A HealthChoices member gets physical health care through one plan, but mental health and substance use services go to a Behavioral Health MCO assigned by the member's county of residence. Philadelphia has its own, Community Behavioral Health. Community HealthChoices members, including many dual-eligible patients, follow the same carve-out. A therapy claim sent to the plan on the member's physical health card will be denied, because that plan isn't the payer.
The state's fee-for-service filing window is short too. Under 55 Pa. Code § 1101.68, the Department of Human Services must receive an original claim within 180 days of the date of service. Exceptions are granted only once, and claims rejected for provider error get no exception at all. If a claim misses the deadline, Medical Assistance rules also bar billing the patient for it.
Expertise
Built for local care models
Deadline Tracking
We flag at-risk claims early
Fewer Denials
Correct coding, less revenue loss
The Full Revenue Cycle We Manage in Pennsylvania
- Patient Access & Eligibility Verification: we confirm the member's physical health plan, county Behavioral Health MCO, and commercial Blue plan before each visit.
- Charge Capture & Coding: CPT, ICD-10, and modifier review against payer edits and NCCI rules.
- Claims Submission: each claim sent to PROMISe, the correct HealthChoices or Behavioral Health plan, or the right commercial payer.
- Payment Posting: ERA reconciliation that checks every payment against your fee schedules and contracts.
- Denial Management & Appeals: denials sorted by root cause, corrected, and appealed within each payer's deadline.
- AR Follow-Up: open claims worked by payer and by days left to file.
- Reporting: monthly KPI reports covering collections, days in AR, and denial trends.
How It Works
From Audit toFaster Payments in 4 Steps
A simple, proven process to streamline your revenue cycle and maximize reimbursements in Pennsylvania.
Free Audit
we review your AR, denials, and payer mix.
Custom Plan
a workflow built for your specialty and your Pennsylvania payers.
Seamless Transition
we take over billing with no gap in cash flow.
Ongoing Reporting
monthly reports show collections and every open claim.
Get Your FreeRevenue Cycle Audit Report
Are Medicaid behavioral health claims going to the wrong Pennsylvania plan? Call +1 434-201-9720 or email info@mediknocx.com for a free revenue cycle audit.
What Makes Our Pennsylvania
Revenue Cycle Management Different
Pennsylvania splits commercial Blue coverage by region and Medicaid behavioral health by county, so our process starts with knowing exactly who owes each claim.
Single-Team Ownership
One team runs eligibility, coding, submission, posting, denials, and AR follow-up for every Pennsylvania claim, so you never have to piece together claim status answers from separate billing vendors or offices.
Regional Blue Plan Routing
We match each patient to Highmark, Independence Blue Cross, or Capital Blue Cross based on their plan and region, then apply that payer's claim edits and appeal rules.
County Behavioral Health Mapping
For Medicaid mental health and substance use services, we identify the Behavioral Health MCO tied to the member's county before billing, including Philadelphia's Community Behavioral Health, so therapy claims reach the right payer.
180-Day Deadline Control
Every fee-for-service Medical Assistance claim is tracked against its 180-day limit, and we correct PROMISe rejections within days, because rejections caused by provider error never qualify for a timely filing exception.
Useful Monthly Reports
Each month you see collections, days in AR, denial rates by payer, and open appeals, plus a short explanation of what changed and what we're working on next.
All 47 Specialties Covered
Our coders know the code sets, modifiers, and payer policies for all 47 specialties we serve, from family practice and pediatrics to cardiology, orthopedics, oncology, and behavioral health.
Specialty Expertise That Works for You
Mediknocx provides revenue cycle management for all 47 medical specialties we serve, including internal medicine, OB-GYN, psychiatry, gastroenterology, orthopedics, neurology, and pain management.
How Does Mediknocx Ensure Compliance
With Pennsylvania Medical Billing Regulations?
No Surprises Act
we support Good Faith Estimates for uninsured and self-pay patients and apply federal balance billing protections to out-of-network claims.
Pennsylvania Timely Filing Law
55 Pa. Code § 1101.68 requires original Medical Assistance claims to reach the Department of Human Services within 180 days of the date of service. For commercial and managed care claims, 40 P.S. § 991.2166 and 31 Pa. Code § 154.18 require insurers to pay clean claims within 45 days of receipt, with 10% annual interest owed on late payments. Medical Assistance and CHIP managed care plans must also pay clean claims within 45 days.
Pennsylvania Billing Transparency
under 55 Pa. Code § 1101.63, the Medical Assistance payment plus any required copayment is payment in full. Practices can't bill recipients for covered services, including claims denied for missing the 180-day limit. Our statements show patients only what they actually owe.
Payer-Specific Guidelines
we follow the published manuals of Highmark, Independence Blue Cross, Capital Blue Cross, the HealthChoices and Community HealthChoices plans, and each county's Behavioral Health MCO.
Healthcare Billing Services Across Pennsylvania Cities
We support practices in Philadelphia, Pittsburgh, and Allentown, and across the rest of the Commonwealth.
- Philadelphia
- Pittsburgh
- Allentown
- Reading
- Erie
Nationwide Revenue Cycle Management
Mediknocx also supports practices in Texas, Georgia, Florida, California, Arizona, North Carolina, Tennessee, Michigan, Illinois, and New Jersey.
Make sure every Pennsylvania claim reaches the payer that owes it. Request your free RCM audit at +1 434-201-9720 or info@mediknocx.com.
Frequently Asked Questions
Find answers to the most common questions about our revenue cycle management services in Pennsylvania.
