Medtransic provides expert medical billing services across Pennsylvania. With Philadelphia and Pittsburgh anchoring two of the nation's premier healthcare markets, world-class institutions like Penn Medicine and UPMC, and a complex Medicaid managed care system, Pennsylvania practices demand billing excellence and regulatory compliance.
Medtransic delivers comprehensive medical billing and revenue cycle management services to healthcare providers throughout Pennsylvania. Our team of certified medical coders and billing specialists understands the unique regulatory environment, payer mix, and healthcare challenges that Pennsylvania practices face. Whether you operate a solo practice or a multi-location clinic, our customized billing solutions help maximize reimbursement, reduce claim denials, and accelerate collections so you can focus on delivering quality patient care.
Why Partner with Medtransic in Pennsylvania
Healthcare providers across Pennsylvania choose Medtransic for our proven track record of delivering measurable results in medical billing and revenue cycle management.
98% First-Pass Acceptance Rate — Clean claims submitted within 24-48 hours, reducing rejections and accelerating payments
25% Average Revenue Increase — Our clients see significant revenue growth within 90 days of onboarding
45% Denial Rate Reduction — Proactive denial prevention with root cause analysis and targeted appeals
HIPAA-Compliant Operations — SOC 2 certified, fully HIPAA compliant with encrypted data handling
Dedicated Account Manager — A single point of contact who knows your practice, specialty, and payer mix
No Long-Term Contracts — Month-to-month flexibility with transparent pricing and no hidden fees
Why Pennsylvania Practices Choose Medtransic
Healthcare providers across Pennsylvania partner with Medtransic because of our proven track record of improving practice revenue and reducing administrative burden.
PA Medicaid Managed Care
Expert billing for Pennsylvania's HealthChoices Medicaid managed care across all physical health, behavioral health, and LTSS programs.
Dual Metro Expertise
Deep knowledge of both Philadelphia and Pittsburgh healthcare markets and their distinct payer landscapes.
Academic Medical Billing
Specialized billing for Pennsylvania's prestigious academic medical centers and teaching hospital networks.
Act 112 Compliance
Ensure compliance with Pennsylvania's Act 112 surprise billing protections and fair billing practices.
See How Much Revenue Your Pennsylvania Practice Is Leaving on the Table
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Pennsylvania has surprise billing protections (Act 112, 2020) that prohibit balance billing for emergency services and establish a dispute resolution process. The state also maintains comprehensive consumer protection standards.
Statute of Limitations: 4 years for medical debt collections in Pennsylvania.
Timely Filing: Claims must generally be filed within 365 days, though individual payer contracts may impose shorter deadlines.
Surprise Billing Protection: Pennsylvania has enacted surprise billing protections for patients.
Act 112 surprise billing protections (2020)
Balance billing prohibited for emergencies
Dispute resolution process
Consumer protection standards
Medical Billing Services We Offer in Pennsylvania
Our full suite of revenue cycle management services is available to healthcare practices across Pennsylvania. Each service is tailored to meet the specific needs of your practice and specialty.
Denial Management - Proactive denial prevention and aggressive appeals to recover lost revenue for Pennsylvania practices
Medical Coding - Certified ICD-10, CPT, and HCPCS coding by specialists familiar with Pennsylvania payer requirements
Accounts Receivable Management - Systematic follow-up on outstanding claims to reduce days in AR and improve collections
Provider Credentialing - Complete payer enrollment and credentialing for Pennsylvania insurance networks
Compliance Auditing - Regular audits to ensure your practice meets Pennsylvania and federal billing compliance standards
Patient Billing - Clear, professional patient statements and payment processing
Telehealth Billing - Virtual visit reimbursement following Pennsylvania telehealth regulations
Medtransic provides specialty-specific billing expertise for healthcare practices across Pennsylvania. Our coders are trained in the unique coding and billing requirements of each medical specialty.
Medtransic serves healthcare providers across every part of Pennsylvania with localized billing expertise.
Philadelphia & Southeast PA
Philadelphia is one of the densest academic medical center markets in the country, with Penn Medicine, Jefferson Health, and Temple Health competing alongside numerous specialty practices. Independence Blue Cross dominates the commercial payer landscape in the region, while complex Medicaid managed care through the HealthChoices program serves a large low-income population.
The concentration of teaching hospitals creates a unique billing environment where academic practice plans, resident supervision requirements, and split/shared billing rules are everyday considerations.
Key specialties in demand: Oncology, cardiology, neurology, orthopedics, psychiatry, gastroenterology
Pittsburgh & Western PA
Pittsburgh's healthcare market is uniquely shaped by UPMC, which serves as both the region's largest employer and a major health insurer through UPMC Health Plan. Allegheny Health Network, backed by Highmark Blue Cross Blue Shield, competes directly, creating a distinctive payer-provider dynamic found nowhere else in the country.
Strong union and employer-sponsored coverage from the region's manufacturing and energy sectors adds another layer of payer complexity that practices must navigate.
Key specialties in demand: Primary care, orthopedics, cardiology, transplant medicine, oncology
Our Track Record in Pennsylvania
Medtransic has a strong track record of delivering results for healthcare practices in Pennsylvania.
320++ practices served across Pennsylvania
85++ billing specialists dedicated to Pennsylvania accounts
18++ years of experience in Pennsylvania medical billing
98% first-pass claim acceptance rate
25% average revenue increase for Pennsylvania practices
45% average denial rate reduction
Frequently Asked Questions About Medical Billing in Pennsylvania
How does PA Act 112 (surprise billing) affect medical billing in Pennsylvania?
PA Act 112 protects patients from surprise out-of-network medical bills for emergency services and inadvertent out-of-network services at in-network facilities. The law limits patient responsibility to in-network cost-sharing amounts and establishes a dispute resolution process between providers and insurers. Medtransic ensures all applicable Pennsylvania claims are processed in compliance with Act 112 and pursues fair reimbursement through the dispute resolution process.
How does Pennsylvania Medical Assistance (Medicaid) managed care billing work?
Pennsylvania's Medicaid program operates through the HealthChoices managed care program, with MCOs including AmeriHealth Caritas, UPMC for You, Keystone First, and Aetna Better Health managing benefits across the state. Each MCO has different authorization, formulary, and claims requirements. Our team maintains current knowledge of every HealthChoices MCO's billing rules to maximize reimbursement for Pennsylvania providers.
What are the Workers' Compensation billing requirements in Pennsylvania?
Pennsylvania Workers' Compensation follows a fee schedule based on Medicare rates with specific conversion factors and billing codes. Providers must be enrolled with the Bureau of Workers' Compensation and use proper documentation linking treatment to workplace injuries. Medtransic handles PA Workers' Comp billing from initial claim submission through utilization review and fee dispute resolution.
What are Pennsylvania's prompt pay requirements for insurance claims?
Pennsylvania law requires insurers to pay or deny clean claims within 30 days of receipt for electronic submissions and 45 days for paper claims. Insurers that miss these deadlines owe interest at 10% per year on the unpaid amount. Medtransic tracks all Pennsylvania claim payment timelines and files regulatory complaints when payers fail to meet their prompt pay obligations.
How do Highmark and UPMC payer dynamics affect billing in Pennsylvania?
The ongoing competitive tension between Highmark Blue Cross Blue Shield and UPMC Health Plan creates a unique billing landscape in western Pennsylvania where network status, referral requirements, and reimbursement rates differ significantly between the two systems. Providers must carefully manage their contracts and credentialing with both entities. Medtransic helps Pennsylvania practices navigate this complex payer relationship to maintain optimal network status and reimbursement from both systems.
How much do medical billing services cost in Pennsylvania?
Medical billing outsourcing for Pennsylvania practices typically ranges from 4-8% of monthly collections, depending on practice size, specialty, and claim volume. Medtransic offers transparent, competitive pricing with no hidden fees. Most Pennsylvania practices see a net revenue increase after partnering with us because of reduced denials and faster collections. View our pricing plans for details.
How do I get started with Medtransic in Pennsylvania?
Getting started is simple. Contact us for a free practice assessment where we analyze your current billing processes and identify improvement opportunities. Our onboarding typically takes 2-4 weeks, during which we integrate with your existing EHR system and begin processing claims with zero disruption to your practice.
Get Started with Medical Billing Services in Pennsylvania
Ready to optimize your Pennsylvania practice's revenue cycle? Contact Medtransic today for a free, no-obligation practice assessment. Call us at 888-777-0860 or submit a contact form to speak with a billing specialist who understands Pennsylvania healthcare. Let us handle the billing complexities so you can focus on what matters most — your patients.