Medicaid Pennsylvania
Medicaid Pennsylvania is a Medicaid managed-care plan operating in Pennsylvania. For an ASC, what matters isn't the logo. It's how Medicaid Pennsylvania pays: where it runs rich, where it runs thin, and how its reimbursement compares with peer plans for the same procedures.
Pilot Analysis
Get the complete Medicaid Pennsylvania analysis
Tell us where to send it. Our team will prepare an analysis of Medicaid Pennsylvania covering rates by code, market position, and underpaid areas, and email it to you within 5-10 business days. Need it faster? Book a demo.
What Insights reveals
How Medicaid Pennsylvania pays
See how Medicaid Pennsylvania reimburses across procedures and markets, benchmarked against the peer plans competing for the same cases. Not a raw rate sheet, a read on where it sits.
Geographic footprint
Medicaid Pennsylvania's presence spans Pennsylvania. See where it concentrates and how that shapes the markets you compete in.
Peer position
Put your own position next to the benchmark for Medicaid Pennsylvania and bring the gap to your next contract conversation.
Specialty mix
Understand which procedures and specialties drive Medicaid Pennsylvania's volume, so you know where a rate change moves the needle.
Whether you're an ASC benchmarking a contract or a provider team looking Medicaid Pennsylvania up, DataLily AI maps how it reimburses across procedures and markets, and where your own rates sit against the peer benchmark.
Reference
Working with Medicaid Pennsylvania
- Payer ID
- 236003113 is the EDI identifier used to route electronic eligibility checks (270/271), claim-status inquiries (276/277), and claims to Medicaid Pennsylvania through a clearinghouse.
- Eligibility verification
- Coverage and benefits for Medicaid Pennsylvania members are verified before the date of service, through a clearinghouse using payer ID 236003113or through the payer's provider portal.
- Prior authorization
- Requirements are set per plan and per procedure. Confirm whether an authorization is required with Medicaid Pennsylvania directly before the date of service.
Book a demo: pick a time
A 15-minute walkthrough of Medicaid Pennsylvania the way it pays.
- What is Medicaid Pennsylvania's payer ID?
- Medicaid Pennsylvania's electronic payer ID is 236003113. ASC billing teams use it to route eligibility checks (270/271), claim-status inquiries (276/277), and electronic claims to Medicaid Pennsylvania through a clearinghouse.
- How do ASCs verify eligibility for Medicaid Pennsylvania members?
- Eligibility and benefits for Medicaid Pennsylvania members are verified before the date of service, either electronically through a clearinghouse (a 270/271 transaction using payer ID 236003113) or through the payer's provider portal.
- Does Medicaid Pennsylvania require prior authorization for ASC procedures?
- Prior-authorization requirements for Medicaid Pennsylvania are set per plan and per procedure. Confirm whether an authorization is required with Medicaid Pennsylvania directly before the date of service.
- What type of payer is Medicaid Pennsylvania?
- Medicaid Pennsylvania is a Medicaid managed-care plan operating in Pennsylvania.
- How does Medicaid Pennsylvania compare with other payers for ASC procedures?
- Ask Rose and you get a plain-language read on where Medicaid Pennsylvania pays above or below peer plans for your top procedures, charted, and ending in a recommendation you can take into a contract conversation.
- Is Medicaid Pennsylvania paying my ASC below market?
- Put your own Medicaid Pennsylvania contract next to the peer benchmark in DataLily AI and you'll see the gap by procedure and market, the fastest way to know whether you're leaving money on the table.