Coverage profile
How Substrate can help you with Medicaid Pennsylvania
Substrate can help practices and billers with the following claims tasks for Medicaid Pennsylvania.
Claim status
EDI 276/277The Substrate Claim Status Agent can check clearinghouse claim status for your practice with Medicaid Pennsylvania.
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Medicaid Pennsylvania.
Frequently asked questions
Medicaid Pennsylvania payer FAQs
How do I check claim status with Medicaid Pennsylvania?
Providers check Medicaid Pennsylvania via EDI 276/277 when the payer ID is accepted. Substrate automates claim status across 3,500+ payers.
What is the payer ID for Medicaid Pennsylvania?
The primary payer ID for Medicaid Pennsylvania is 236003113. The correct routing ID can differ by clearinghouse and transaction, so compare the 837P, 837I, 835, 270, and 276 entries before submitting.
What are the 837 payer IDs for Medicaid Pennsylvania?
The 837P and 837I payer ID for Medicaid Pennsylvania is 236003113 via Stedi.
What is the 835 payer ID for Medicaid Pennsylvania?
The 835 payer ID for Medicaid Pennsylvania is 236003113 via Stedi.
What is the 270 payer ID for Medicaid Pennsylvania?
The 270 payer IDs for Medicaid Pennsylvania are 236003113 via Stedi and 236003113 via Availity.
What is the 276 payer ID for Medicaid Pennsylvania?
The 276 payer ID for Medicaid Pennsylvania is 236003113 via Stedi.
What state does Medicaid Pennsylvania operate in?
Medicaid Pennsylvania operates in PA.
Routing reference
Medicaid Pennsylvania payer IDs and operating states
Use the payer ID listed for the transaction you are submitting. Verify current routing and enrollment requirements with your clearinghouse.
| Payer name | Medicaid PennsylvaniaSource: Substrate payer directory · last refreshed |
|---|---|
| Operating states | PASource: Substrate payer directory · last refreshed |
| 837P professional claims payer IDStedi | 236003113Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 837I institutional claims payer IDStedi | 236003113Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 835 ERA payer IDStedi | 236003113Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDStedi | 236003113Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDAvaility | 236003113Source: Availity payer catalog · catalog dated · matched by payer ID |
| 276 claim status payer IDStedi | 236003113Source: Stedi payer catalog · catalog dated · matched by payer ID |
Routing sources and verification
- Substrate payer directoryPayer identity, aliases, operating states, and vendor IDs. Last refreshed .Open payer website ↗
- Stedi payer catalogMatched by payer ID; matched record: Medicaid Pennsylvania. Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi reference ↗
- Availity payer catalogMatched by payer ID; matched record: MEDICAID PENNSYLVANIA. Source dated .The attached API workbook supplies 270 and 276 payer IDs only. It does not supply 837P, 837I, or 835 IDs.Open current Availity reference ↗
Clearinghouse payer IDs are transaction-specific and can change. Confirm the current payer list and the member’s ID card before submission.
Payer contact directory
Medicaid Pennsylvania phone and fax numbers
Use the number associated with your task. These contacts were stated in successful eligibility responses and may apply to specific benefits, products, or departments.
- Other stated context phone
- (412) 454-2120BHNS-COMMUNITY CARE
| Channel and number | Payer Notes | Department | Specialties |
|---|---|---|---|
| phone(800) 537-8862 | Other stated context, PharmacyBenefit context: Active Coverage |
| Health Benefit Plan Coverage, Medical Care, Diagnostic X-Ray, Health Benefit Plan Coverage, Chiropractic, Dental Care, Hospital, Hospital - Inpatient, Hospital - Outpatient, Emergency Services, Pharmacy, Professional (Physician) Visit - Office, Psychotherapy, Vision (Optometry), Mental Health, Urgent Care |
| phone(800) 424-3711 | Behavioral healthBenefit context: Active - Services Capitated |
| Health Benefit Plan Coverage |
| phone(888) 251-2224 | Behavioral health, Other stated contextBenefit context: Active - Services Capitated |
| Health Benefit Plan Coverage |
| phone(412) 454-2120 | Other stated contextBenefit context: Active - Services Capitated |
| Health Benefit Plan Coverage |
| phone(800) 392-1147 | Other stated contextBenefit context: Active - Services Capitated |
| Health Benefit Plan Coverage |
| phone(800) 521-6007 | Other stated contextBenefit context: Active - Services Capitated |
| Health Benefit Plan Coverage |
| phone(800) 521-6860 | Other stated contextBenefit context: Active - Services Capitated |
| Health Benefit Plan Coverage |
| phone(844) 626-6813 | Other stated contextBenefit context: Active - Services Capitated |
| Health Benefit Plan Coverage |
| phone(844) 860-9303 | Other stated contextBenefit context: Active - Services Capitated |
| Health Benefit Plan Coverage |
| phone(855) 227-1302 | Other stated contextBenefit context: Active - Services Capitated |
| Health Benefit Plan Coverage |
| phone(866) 918-1595 | Other stated contextBenefit context: Active - Services Capitated |
| Health Benefit Plan Coverage |
| phone(888) 991-9023 | Other stated contextBenefit context: Active - Services Capitated |
| Health Benefit Plan Coverage |
Phone and fax numbers sourced directly from the payer response
Other aliases
Also known as
- 10165
- 12008
- 1491
- 1605
- 236003113
- 5509
- 6845
- CKPA1
- PACAID
- PAMCD
- SKPA0
- Pennsylvania Medicaid
- Pennsylvania Medical Assistance
- MEDICAID PENNSYLVANIA (DENTAL)