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June 1, 2012 - May 31, 2013
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.
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: