Workers Compensation Billing in Pennsylvania

Novitas Solutions (JL). That contractor adjudicates Medicare claims for Pennsylvania providers, publishes the local coverage determinations that bind you, and hears the first level of appeal. An argument that works with them works across every state they cover.

It runs as HealthChoices, delivered largely through commercial managed care plans. So most Pennsylvania Medicaid claims are adjudicated by an insurer with its own filing window, its own authorization rules, and its own appeal path — not by the state. Nationally about 78% of Medicaid beneficiaries sit in comprehensive managed care, and five companies hold roughly half of that enrollment.

Pennsylvania is a no-fault state. For an auto injury the auto carrier is the payer of first resort, not the health plan. Billing the health plan first produces a denial that reads like a coverage problem but is a sequencing problem, and by the time it arrives the auto carrier's own window has been running.

A percentage of collections, banded by practice size, with a monthly minimum so a smaller practice is served properly rather than quoted a rate that does not cover the work. The Pennsylvania rate card is on the state page.

No — we work remotely with practices in all 50 states and DC. What matters is that somebody is tracking Pennsylvania's rules against your actual claims: its Medicare contractor, its Medicaid structure, and its auto-injury sequencing.

bill against the applicable state fee schedule rather than your commercial rates, track authorization and reporting requirements specific to the jurisdiction, manage the documentation these carriers require and commercial payers do not, and the follow-up that goes with them. Comp claims are billed to the schedule that governs them and followed up on the timeline they actually run on.