Philadelphia, PA

Medical Billing Services in Philadelphia, PA

Medical billing for Philadelphia practices handling HealthChoices plans, Independence Blue Cross, Medicare and patients from both sides of the Delaware River.

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Revenue Cycle Support for Philadelphia Practices

Medical billing in Philadelphia comes with a long list of moving parts. Practices see Medicaid patients in HealthChoices plans, commercial patients with Independence Blue Cross and other carriers, Medicare and Medicare Advantage patients, and often New Jersey residents with coverage from across the river. A busy front desk can miss an eligibility change or an authorization requirement, and the claim does not come back denied until weeks later.

Unstoppable Revenue provides medical billing services and revenue cycle management to Philadelphia practices remotely from our team in Dallas, handling claims, eligibility, prior authorization, coding, payment posting, denial management and AR follow-up through HIPAA-conscious processes. For a multi-provider mental health practice we support, that work led to a 9-day reimbursement turnaround and a $1M reduction in AR over 12 months. Results vary by practice, but the approach is the same: find where money is stuck and fix the cause.

Pennsylvania Medical Assistance and Local Payers

Pennsylvania's Medicaid program, Medical Assistance, runs most physical health coverage through HealthChoices managed care organizations, with fee-for-service claims processed through the state's PROMISe system. In Philadelphia, behavioral health services under HealthChoices are managed separately by Community Behavioral Health, the city's behavioral health managed care organization. Practices that offer both physical and behavioral services need to know exactly which payer handles which claim.

Independence Blue Cross is the leading commercial insurer in southeastern Pennsylvania, so its policy updates and prior authorization lists affect a large share of claims. Practices near the river may also see patients covered by Horizon Blue Cross Blue Shield of New Jersey. We keep payer rules organized for your practice so denials are worked by pattern and cause, not one at a time.

We support practices in Center City, University City, Northeast Philly and Germantown, as well as Bucks, Montgomery, Delaware and Chester counties and South Jersey.

Medical Billing Services for Philadelphia Practices

Medical Coding

Coding review that matches documentation to the right CPT and ICD-10 codes and modifiers, including the behavioral health and evaluation codes that tend to draw payer scrutiny.

Charge Entry and Audit

Charges entered accurately and audited against the visit record, catching missing services, wrong units and mismatched diagnoses before the claim is submitted rather than after a payer flags it.

Eligibility and Prior Authorization

Coverage confirmed before visits, including which HealthChoices plan a patient is assigned to, with authorizations requested and tracked so services are not delivered without approval.

Denial Management and Appeals

Denials grouped by cause, appealed when documentation supports it and tracked over time, so the same coding or eligibility problem does not keep costing you money.

Billing Reports and Statements

Monthly medical billing reports on collections, AR aging and denials, plus clear, easy-to-read patient statements that reduce billing calls to your staff and help patients pay their share sooner.

FAQs

Medical billing in Philadelphia: common questions

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