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.
Learn about our claims address, electronic payer IDs, provider dispute information, provider appeals, and more.
- Claims filing guide (PDF)
- June 1, 2020, new and current explanation of benefit (EOB) codes (PDF)
- EDI-EFT-ERA electronic billing services
- Eligibility verification guide (PDF)
- Provider quick reference guide (PDF)
- Supplemental billing information for modifiers 25 and 59(PDF)
Additional billing information
- Fraud, waste, and abuse information
- Medical Assistance fee schedules
- Member copay schedule (PDF)
- Services reimbursed above capitation (PDF)
Third-party liability (TPL) is when the financial responsibility for all or part of a member's health care expenses rests with an individual entity or program (e.g., Medicare, commercial insurance) other than AmeriHealth Caritas Pennsylvania.