Medical Billing Services in Pennsylvania
Pennsylvania's HealthChoices managed care roster, an in-flux long-term-care rebid, and a high-risk provider revalidation deadline all affect how claims should be billed right now.
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HealthChoices physical-health managed care plans
Pennsylvania delivers Medicaid managed care through HealthChoices, organized into five zones. The plans operating in each zone, per the DHS Statewide MCO Map:
| Zone | Plans |
|---|---|
| Southeast | Geisinger Health Plan, Jefferson Health Plans EverWell, Keystone First, UnitedHealthcare Community Plan, UPMC for You |
| Southwest | AmeriHealth Caritas Pennsylvania, Geisinger Health Plan, Jefferson Health Plans EverWell, Highmark Wholecare, UPMC for You |
| Lehigh/Capital | AmeriHealth Caritas Pennsylvania, Geisinger Health Plan, Jefferson Health Plans EverWell, Highmark Wholecare, UPMC for You |
| Northeast | AmeriHealth Caritas Pennsylvania, Geisinger Health Plan, Jefferson Health Plans EverWell, UPMC for You |
| Northwest | AmeriHealth Caritas Pennsylvania, Geisinger Health Plan, Jefferson Health Plans EverWell, UPMC for You |
Aetna is no longer part of this roster. Confirm a patient's specific plan and zone before billing — a claim sent to the wrong MCO for a county is a common, avoidable denial.
Community HealthChoices — time-sensitive
Time-sensitive: The Community HealthChoices (long-term care) program is operating under a court-ordered rebid as of April 2026, after the Commonwealth Court reversed a prior contract award decision. The current incumbents are not settled for the next contract term — confirm the active CHC plan roster before relying on it for new enrollments or long-term billing arrangements.
High-risk provider revalidation deadline
Time-sensitive: Per MA Bulletin 99-26-06, DHS set an off-cycle revalidation deadline of December 31, 2026 for providers categorized as high-risk — specifically, those who revalidated before July 1, 2025, and select high-risk providers who revalidated on or after that date — regardless of their normal five-year revalidation date. A provider location that misses its deadline is closed in PROMISe. Each service location must be revalidated separately, and DHS recommends submitting at least 60 days ahead of the applicable date.
Confirming the right MCO and keeping enrollment current depends on credentialing and clean eligibility verification. A billing audit can flag claims already denied for MCO mismatch or lapsed enrollment.
Last verified: November 2026
Frequently asked questions
No — the current DHS roster no longer includes Aetna in any zone.
No — as of April 2026 the CHC award is under a court-ordered rebid, so the incumbent roster should be treated as unsettled.
DHS closes that provider location in PROMISe, per MA Bulletin 99-26-06.