Statewide Healthcare RCM Coverage • 1,886 Cities & Towns
Medical Billing & RCM Services in Pennsylvania
Delivering tailored medical coding, billing, and credentialing services across Pennsylvania. Serving healthcare providers, clinics, and hospital groups with an exceptional 98% clean claim rate.
Statewide Regulatory & MAC Compliance Hub
Pennsylvania Medicare MAC Jurisdiction & Payer Regulations (J-L)
Comprehensive Part A/B Medicare contractor policies, LCD standards, and state Medicaid filing rules for Pennsylvania medical practices.
98.2% First-Pass Clean Claim Rate
Medicare Administrative Contractor (MAC)
J-L
Jurisdiction L (J-L)
Contractor:
Novitas Solutions, Inc. (HQ: Mechanicsburg, PA)
State Medicaid & Public Health Agency
PA
Pennsylvania Department of Human Services (PROMISe)
Governing Agency:
Pennsylvania Department of Human Services (DHS)
Medicaid Timely Filing:
180 days from Medicare Remittance (RA) date
Medicare Timely Filing Window
12 months (365 days) from Date of Service
First-Level Appeals (Redetermination)
120 calendar days from Remittance Advice (Redetermination)
First-Pass Clean Claim Target
98.2% Scrubber Rate
Active Local Coverage Determinations (LCDs) in Pennsylvania (J-L):
4 Active LCDs
L35396
Biomarkers for Oncology
L35056
Transesophageal Echocardiography (TEE)
L35091
Non-Invasive Vascular Studies
L35076
Stereotactic Radiosurgery (SRS) & SBRT
Regional Billing Nuances & Compliance Safeguards:
Maryland Total Cost of Care (TCOC) All-Payer Model: While Maryland hospitals operate under global budgets, Medicare Part B physician claims are billed directly to Novitas J-L using national Part B rules.
Pennsylvania PROMISe & New Jersey FamilyCare: PA PROMISe requires 13-digit Provider ID mapping on secondary crossover claims within 180 days of Medicare RA.
DC Department of Health Care Finance (DHCF) electronic crossover claim adjudication.
Mandatory single-use drug vial wastage recording with JW/JZ modifiers.
Healthcare Locations & Cities in Pennsylvania
Select your city below for specialized local medical billing solutions and regional payer expertise.