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.
Claims will be denied if ordering, referring, or prescribing provider is not enrolled in the MA program.
Enroll in the Pennsylvania MA program.
Billing information
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 funds transfer (EFT)
- Submit claims electronically
Billing guides
- Provider quick reference guide (PDF)
- Claims filing guide for HCBS providers (PDF)
- Claims filing guide for medical providers (PDF)
- Electronic services quick guide (PDF)
- Eligibility verification guide (PDF)
- Supplemental billing information for modifiers 25 and 59 (PDF)