• • Apply for Benefits
  • Search for Provider / Inspection Results
  • Helpful Telephone Numbers
  • Find a Form
  • Find Facilities and Locations
  • Learn About DPW

• • For Adults
  • For Children
  • For Disability Services

Home | Provider | Doing Business with DPW | Software and Service Vendors | Certified Software Vendors/Clearinghouses/Service Bureaus

Certified Software Vendors/Clearinghouses/Service Bureaus

Click on the appropriate hyperlink below to view a current listing of PA Certified vendors, clearinghouses or service bureaus who supply specific systems or services capable of transmitting electronic transactions to HP for Pennsylvania Medical Assistance.

• 270/271 Eligibility Software and Point of Sale (POS) Device Vendors - submit eligibility transactions on behalf of providers or provide software or POS devices capable of completing interactive and/or batch eligibility transactions.
• 837 Electronic Billing Vendors - submit claims on behalf of providers or sell software capable of completing Institutional, Long Term Care, Dental, and Professional billing transactions.
• NCPDP (Pharmacy) Vendors – submit claims on behalf of providers or offer software capable of completing interactive and/or batch pharmacy transactions. 

---

• ANSI X12 v5010 Certified 837 Billing Software and Service Vendors - ANSI X12 v5010 Certified Software Vendors who submit claims on behalf of providers or sell software capable of transmitting a certified 387 transaction.

These listings are updated as new vendors, clearinghouses and service bureaus are certified and do not imply endorsement of any product or service. All software vendors, clearinghouses or service bureaus on these lists have electronic transaction submission software that has been tested and approved by HP for PA HIPAA/PROMISe™ compliance. These lists are provided for the convenience of providers and suppliers who are interested in pursuing electronic claims submission for their Pennsylvania Medical Assistance claims. The lists are not all-inclusive. There may be other software vendors, clearinghouses and service bureaus who support electronic claims submission. HP will accept claims from any product that meets its electronic claim submission requirements. Questions about these listings should be directed to HP's Provider Assistance Center at 1-800-248-2152 (local 717-975-4100).

NOTE: Although HP has certified the capability of each listed software to submit HIPAA/PROMISe™ compliant transactions, it remains the responsibility of the provider to ensure that correct data is submitted in order for the Medical Assistance Program to successfully process transactions.

Tips for Selecting a Software or Service Vendor

Choosing an electronic claims system means deciding between two basic options. You may either file claims directly with Pennsylvania Medical Assistance or submit them through a service bureau or clearinghouse.

Direct-filing systems usually cost more up front. They are less expensive in the long run, however, because you don't have to pay the per-claim fees charged by the service bureaus or clearinghouses. For that reason, many smaller practices choose the direct-filing option. It may still be necessary to send paper claims to other insurers.

Typically, claims sent to a service bureaus or clearinghouses are electronically edited for accuracy, format, and completeness. Then they are sorted and distributed to the appropriate carriers. Incorrect or incomplete claims are returned to you for correction and resubmission.

Regardless of how your claims are filed, you remain ultimately responsible for their accuracy and timeliness. It is your responsibility to provide billers with information received from the Department. Additionally, you should be aware that some electronic claims cannot be processed by Medical Assistance due to incorrect format or invalid provider information. These claims will not appear on your paper remittance advice, but are returned electronically to the service bureau or clearinghouse. You should check with your selected service bureau or clearinghouse to confirm that they understand they are responsible for correcting and resubmitting these claims.

You may find the tips below helpful in choosing a vendor:

• Ask your practice management consultant (if you have one) to recommend a qualified dealer or software system.
• Ask your colleagues in similar practices about their experiences with electronic claims submission. Visit their offices to see the systems in operation. Ask them about the features they like and don't like. Ask about their satisfaction with the service received from the vendor.
• Visit the vendor displays at the next professional meeting you attend. Discuss your specific needs with the salespeople. Read their literature, examine their systems, and ask for a demonstration.
• Check out the vendor's credit record, business history and financial condition. Ask each vendor for a list of local clients in your field of practice.
• Determine whether the vendor's system will integrate with your existing system. Ask if you'll get credit for the cost of a software upgrade after a few years.
• Make sure that any new computer or software system you buy will be capable of electronic claims submission to Pennsylvania Medical Assistance.
• Find out how often your vendor will update your system to comply with changes to Pennsylvania Medical Assistance. Will the vendor reprogram your system at no extra charge?
• Ask about provisions for training your staff on the new software system. The level of support you receive after you buy the software is an important factor as well.