The Pennsylvania RCM Authority
Master Revenue in
Pennsylvania.
Philadelphia.
Pittsburgh.
Allentown.
Harrisburg.
Operating a practice in the Keystone State means navigating Highmark & Independence BCBS complexities, massive academic health networks, and strict Novitas (JL) guidelines. We engineer 98% clean claim rates to ensure your cash flow never stalls.
Takes less than 60 seconds
98%
Clean Claims
9+
Years in AL
$2B
Revenue Managed
- HBS PA-GATEWAY
Novitas (JL)
LCD Scrubber Rules
Synced
Highmark/IBX
Policy & Modifiers
Active
PA Medicaid
Provider Portal Sync
Scanning
Core Capabilities
The HBS Advantage in PA.
Beyond standard billing, we offer a comprehensive revenue cycle management ecosystem tailored specifically for Pennsylvania’s mix of massive academic health systems, corporate networks, and rural clinics.
AI-Driven Scrubbing
Our proprietary rules engine preemptively identifies coding errors and Novitas (JL) LCD mismatches before claims ever reach the payer, ensuring our 98% clean claim rate.
Dedicated PA Teams
You don’t get a generalized call center. You are assigned a dedicated pod of RCM specialists who strictly handle Pennsylvania accounts and understand the nuances of Highmark/Independence commercial plans and state Medicaid.
Transparent Analytics
Stop guessing about your financial health. We provide real-time, granular dashboards showing exact A/R aging, denial reasons, and daily cash flow projections.
Seamless Transition
How We Partner With You.
We designed our onboarding to be frictionless. We integrate with your existing systems without disrupting your daily patient care.
1
Deep-Dive Audit
We analyze your historical data to identify leaks in your revenue cycle.
2
EHR Integration
Secure, remote tunnels into your Epic, Cerner, Athena, or cloud EHR system.
3
A/R Rescue
Our specialists immediately attack your aging buckets (>90 days).
Maximized Profit
Our specialists immediately attack your aging buckets (>90 days).
Operational Footprint
Statewide Integration.
We securely tunnel into your existing EHR remotely, providing world-class RCM support across the state. We understand the specific payer nuances in every major Pennsylvania region.
Philadelphia Metro
Primary Challenge: Massive concentration of academic medical centers (Penn Medicine/Jefferson), complex teaching physician rules, and Independence Blue Cross (IBX) dominance.
HBS Solution: Advanced clearinghouse rules engines tailored for complex teaching physician guidelines (modifiers GC, GE) and swift denial appeals for IBX policies.
Top EHRs:
Epic | Cerner
Pittsburgh
Primary Challenge: Intense competition between UPMC and Highmark health systems, creating complex multi-specialty network billing and out-of-network processing hurdles.
HBS Solution: Advanced clearinghouse rules engines tailored for complex commercial networks and rigorous No Surprises Act compliance tracking to protect revenue.
Top EHRs:
Epic | NextGen
Allentown / Cherry Hill
Primary Challenge: Proximity to the New Jersey border requires meticulous cross-state billing and out-of-network processing for commercial plans.
HBS Solution: Automated BlueCard routing and rigorous No Surprises Act compliance tracking to protect revenue from out-of-network disputes.
Top EHRs:
ModMed | eCW
Harrisburg
Primary Challenge: High volume of state employee health plans and Pennsylvania Medicaid (Medical Assistance) billing rules.
HBS Solution: Mastery of PROMISe portal synchronization, specific state plan coding guidelines, and optimizing public health claims.
Top EHRs:
AdvancedMD | Kareo
Erie
Primary Challenge: Aging demographics driving high Medicare (Novitas JL) volume, chronic care management billing, and cross-border NY/OH complications.
Primary Challenge: Aging demographics driving high Medicare (Novitas JL) volume, chronic care management billing, and cross-border NY/OH complications.
Top EHRs:
Allscripts | Epic
Rural Pennsylvania
Primary Challenge: Rural Health Clinic (RHC) billing complexities, heavy reliance on Telehealth, and PA Medical Assistance management.
HBS Solution: Deep expertise in PPS rate reconciliation, mastery of Telehealth modifiers (95, GT), and specialized RHC modifier management.
Top EHRs:
Elation | DrChrono
Proven Results
Pennsylvania Success Stories.
Real data from practices across the Keystone State that transformed their revenue cycles by partnering with HBS.
Multi-Specialty Clinic
Philadelphia, PA
Struggled with massive A/R aging > 90 days due to complex IBX pre-authorizations and Novitas (JL) audits.
A/R > 90 Days
-76%
Monthly Cash Flow
+$142K
Orthopedic Center
Pittsburgh, PA
Plagued by high denial rates (23%) due to complex pre-authorizations and Highmark/UPMC cross-network billing errors.
Denial Rate
3.4%
Clean Claim Rate
98.5%
Secure Your PA Revenue Audit
Stop leaving money on the table. Our Pennsylvania specialists will analyze your revenue cycle and uncover hidden billing opportunities.