Coverage profile
How Substrate can help you with Medicare Pennsylvania Part B
Substrate can help practices and billers with the following claims tasks for Medicare Pennsylvania Part B.
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Medicare Pennsylvania Part B.
2027 maternity billing research
When does Medicare Pennsylvania Part B change OB/GYN billing?
Transition begins 2027-01-01. CMS proposes valuing the new CPT codes but is considering 15 Medicare-specific global maternity HCPCS codes GMAT1-GMAT15 instead.
- Transition start
- 2027-01-01
- Billing start
- Not published
- Published
- 2026-07-16
- Current As Of
- August 2026
Scope: federal Medicare Part B proposal; MAC instructions pending
CY 2027 Physician Fee Schedule proposed rule. Verify the payer source before claim submission.
Frequently asked questions
Medicare Pennsylvania Part B payer FAQs
What is the payer ID for Medicare Pennsylvania Part B?
The primary payer ID for Medicare Pennsylvania Part B is 12502. The correct routing ID can differ by clearinghouse and transaction, so compare the 837P, 837I, 835, 270, and 276 entries before submitting.
What is the 837P payer ID for Medicare Pennsylvania Part B?
The 837P payer ID for Medicare Pennsylvania Part B is 12502 via Stedi.
What is the 835 payer ID for Medicare Pennsylvania Part B?
The 835 payer ID for Medicare Pennsylvania Part B is 12502 via Stedi.
What is the 270 payer ID for Medicare Pennsylvania Part B?
The 270 payer ID for Medicare Pennsylvania Part B is 12502 via Stedi.
What state does Medicare Pennsylvania Part B operate in?
Medicare Pennsylvania Part B operates in PA.
Routing reference
Medicare Pennsylvania Part B 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 | Medicare Pennsylvania Part BSource: Substrate payer directory · last refreshed |
|---|---|
| Operating states | PASource: Substrate payer directory · last refreshed |
| 837P professional claims payer IDStedi | 12502Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 835 ERA payer IDStedi | 12502Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDStedi | 12502Enrollment requiredSource: 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: Medicare Pennsylvania Part B. Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi 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
Medicare Pennsylvania Part B 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.
- Eligibility / benefits phone
- (800) 448-6262HUMANA INSURANCE CO. & HUMANA INSURANCE CO. OF NY, HUMANA INSURANCE COMPANY
| Channel and number | Payer Notes | Department | Specialties |
|---|---|---|---|
| phone(800) 448-6262 | Eligibility / benefits, PharmacyBenefit context: Other or Additional Payor; Benefit context: Contact Following Entity for Eligibility or Benefit Information |
| Health Benefit Plan Coverage, Pharmacy |
| phone(717) 305-7388 | PharmacyBenefit context: Other or Additional Payor |
| Pharmacy |
| phone(866) 235-5660 | PharmacyBenefit context: Other or Additional Payor |
| Pharmacy |
| phone(866) 443-1095 | PharmacyBenefit context: Other or Additional Payor |
| Pharmacy |
| phone(866) 460-8854 | PharmacyBenefit context: Other or Additional Payor |
| Pharmacy |
| phone(877) 327-1395 | PharmacyBenefit context: Other or Additional Payor |
| Pharmacy |
| phone(888) 888-9355 | PharmacyBenefit context: Other or Additional Payor |
| Pharmacy |
Phone and fax numbers sourced directly from the payer response
Other aliases
Also known as
- 12502
- 2457
- PAMCR
- SMPA0