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Radiology Billing Services in Pennsylvania

Built for Novitas Solutions’ five-jurisdiction Jurisdiction L rules and Pennsylvania’s newly reshaped Community HealthChoices program, we keep Pennsylvania radiology groups paid accurately and on time.

Radiology Billing Built Around Pennsylvania's Realities

From Philadelphia to Pittsburgh, Pennsylvania radiology groups bill against a five-jurisdiction Medicare contractor, a dual-eligible Medicaid program with new plans in 2025, and a 45-day prompt pay clock.

Jurisdiction L Medicare rules shared with four other jurisdictions

Community HealthChoices added two new MCOs in 2025

18 critical access hospitals depend on clean radiology reimbursement

10 percent annual interest penalty on claims paid late

Processed Claim Value
$ M+
Avg. A/R Collection Time
0 Days
Turn Around Time (TAT)
0 Hours
Client Retention Rate
0 %
Annual Claims
0 M+
First-Pass Claim Rate
0 %
Avg. Revenue Growth
8- 8 %
Avg. Denial Reduction
0 %

Regulatory Factors Shaping Pennsylvania Radiology Billing

Four regulatory realities define how radiology claims move through Pennsylvania, from Medicare’s Jurisdiction L to the state’s prompt pay statute.

Jurisdiction L Medicare Rules

Novitas Solutions processes Medicare Part A and B claims for Jurisdiction L, covering Pennsylvania, New Jersey, Delaware, Maryland, the District of Columbia, and parts of Virginia. Coverage determinations are set jurisdiction-wide, so an LCD update out of Maryland applies just as directly to a radiology group in Pittsburgh. We track Novitas’s specific bulletins so Pennsylvania claims match the standard actually enforced.

Community HealthChoices Added New Plans in 2025

Pennsylvania’s Community HealthChoices program, coordinating Medicare and Medicaid benefits for more than 383,000 dual-eligible and long-term care members, brought on two new managed care organizations, Aetna Better Health and Health Partners Plans, for contracts starting January 2025. Each of the five CHC plans runs its own prior authorization rules for imaging, so a dual-eligible claim can be processed differently depending on the plan.

A Brand-New Compact Member

Pennsylvania fully implemented the Interstate Medical Licensure Compact on July 7, 2025, letting physicians licensed in other member states apply for an expedited Pennsylvania license. The compact is still new enough that credentialing teams are adjusting their workflows, and a separate payer enrollment step is still required before claims can be billed under a newly licensed radiologist’s NPI.

45-Day Prompt Pay Rule

Under Pennsylvania’s Act 68, insurers and managed care plans must pay clean claims within 45 days of receipt. Any interest owed on a late claim accrues at 10 percent per year and must be paid within 30 days of the claim itself. We build Pennsylvania claims clean on the first pass so they clear inside that 45-day window.

Complete Radiology Revenue Cycle Management

Certified CIRCC and CPC coders handle every CPT code, modifier, and global billing rule specific to diagnostic and interventional radiology — maximizing reimbursement on every encounter across all modalities and payer types.

Where Pennsylvania Radiology Billing Breaks Down

A five-jurisdiction Medicare contractor, five Community HealthChoices plans with different rules, and a brand-new licensure compact all add friction most billing teams aren’t built to absorb.

Before RBS

Dual-eligible claims denied for the wrong CHC plan's prior auth rules

Jurisdiction L denials reworked from scratch every single time

New compact licenses outpacing payer enrollment paperwork

Critical access hospital partners absorbing avoidable denials

Clean claims quietly missing the state's 45-day deadline

After RBS

Dual-eligible eligibility and prior auth verified by CHC plan

Jurisdiction L appeals built on tracked Novitas coverage patterns

Compact licensing and payer enrollment tracked as two separate steps

Critical access hospital partners billing on margins that hold up

Every clean claim timestamped and chased before its deadline passes

Precision RCM & Coding Built for Radiology

Generic billing is the fastest way to a denied radiology claim. RBS delivers specialty-specific revenue integrity built for imaging’s TC/PC splits and modifier rules, so you capture every dollar you’re owed.

Diagnostic Radiology

CT Scan

MRI & MRA

Nuclear Medicine

PET / PET-CT

Ultrasound

Interventional Radiology

Teleradiology

Mammography

DEXA / Bone Density

Hospital Radiology

Radiation Oncology

Coverage Confirmed for Every Payer You Work With

From national carriers to regional Medicaid plans, coverage is checked against the exact payer, plan, and product type on file — never a generic match. Every result reflects current payer policy, not outdated data from months ago.
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana

Serving Radiology Practices Across Pennsylvania

From Philadelphia and Pittsburgh to Allentown, Erie, and Harrisburg, we bill for radiology groups and their hospital partners across the state.

Philadelphia & the Southeast

Cities
  • Philadelphia
  • Norristown
  • Chester
Counties
  • Philadelphia County
  • Montgomery County
  • Delaware County

Pittsburgh & Southwest Pennsylvania

Cities
  • Pittsburgh
  • McKeesport
  • Washington
Counties
  • Allegheny County
  • Westmoreland County
  • Washington County

Lehigh Valley & Northeast

Cities
  • Allentown
  • Bethlehem
  • Scranton
Counties
  • Lehigh County
  • Northampton County
  • Lackawanna County

Central Pennsylvania

Cities
  • Harrisburg
  • Lancaster
  • York
Counties
  • Dauphin County
  • Lancaster County
  • York County

Erie & the Northwest

Cities
  • Erie
  • Meadville
  • Oil City
Counties
  • Erie County
  • Crawford County
  • Venango County

South Central & Southern Alleghenies

Cities
  • Altoona
  • Johnstown
  • State College
Counties
  • Blair County
  • Cambria County
  • Centre County

Wired Into Every System You Already Run

Your EHR, RIS, and PACS stay exactly as they are. We plug our coding workflow directly into what you already use — no migration, no new login for your radiologists, no disruption to how your team already works.

Built for Pennsylvania's Highmark-UPMC Market

Highmark and UPMC, the two health care giants whose years-long access fight once put hundreds of thousands of western Pennsylvania patients at risk, have operated under a decade-long network agreement since 2019, guaranteeing in-network access through June 2029. A practice billing across that market still has to satisfy both organizations’ distinct requirements. We build every claim to clear them the first time.
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Frequently Asked Questions

What Medicare Administrative Contractor handles Pennsylvania radiology claims?

Novitas Solutions processes Medicare Part A and B claims for Jurisdiction L, which also covers New Jersey, Delaware, Maryland, and the District of Columbia. We track Novitas’s specific billing bulletins rather than generic national Medicare guidance.
Pennsylvania added two new managed care organizations, Aetna Better Health and Health Partners Plans, to its five-plan Community HealthChoices lineup for contracts starting January 2025. The program coordinates Medicare and Medicaid benefits for more than 383,000 dual-eligible and long-term care members.
No. Pennsylvania fully implemented the Interstate Medical Licensure Compact on July 7, 2025, which speeds up getting a Pennsylvania medical license, but an out-of-state radiologist still needs that license and separate payer enrollment before claims can be billed under their NPI.
Pennsylvania has 18 critical access hospitals serving its rural counties. Those hospitals depend on clean, accurately paid radiology claims, with very little room for denials or slow appeals to go unchallenged, especially with a 10 percent annual penalty on claims paid late.
Yes. Highmark and UPMC are two of Pennsylvania’s largest health care organizations, so a large share of our clients’ claims run through one or both. We build claims to their specific requirements rather than treating them as generic commercial payers.

Get Pennsylvania Radiology Billing That Keeps Up

From Jurisdiction L appeals to Community HealthChoices’s five-plan maze, let’s talk about what’s actually slowing down your reimbursements.

Jurisdiction L and Novitas-specific claim review

Dual-eligible eligibility and prior auth verified by CHC plan

Compact licensing and payer enrollment tracked end to end

Clean-claim tracking against the 45-day statutory deadline

Critical access hospital billing built for thin rural margins

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What Our Clients Say?

Rebecca Lawson

★★★★★

Radiology Practice Manager

Since partnering with your radiology billing team, our billing workflow has become much smoother. They understand imaging procedures, payer requirements, coding, and claim follow-ups. Their team is responsive, professional, and always stays on top of outstanding claims.

Dr. Christopher Bennett

★★★★★

Medical Director, Diagnostic Imaging Center

Your team truly understands the challenges of radiology billing. They handle claims accurately, follow up on unpaid accounts, and help resolve billing issues efficiently. Their expertise and communication have made our revenue cycle more organized and reliable.

Dr. Andrew Whitaker

★★★★★

Radiologist & Imaging Center Owner

Our team has been an excellent partner for our imaging center. They understand radiology billing, coding, claim submission, denials, and follow-ups. Their attention to detail and consistent communication have helped streamline our billing process and improve our revenue cycle.

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