Trusted Medical Billing Partner
Medical Billing Services in Philadelphia
Pennsylvania splits Medicaid into two entirely separate systems: physical health through HealthChoices MCOs, and behavioral health through county-based BH-MCOs that physical health plans don’t touch at all. In Philadelphia, that means Community Behavioral Health (CBH), and a claim sent to the wrong side of that split simply doesn’t get paid. Techera Med Systems provides medical billing for Philadelphia practices built around that carve-out and the city’s dense concentration of academic medical centers.
How Much Does Medical Billing Cost in Philadelphia?
Techera Med Systems charges a percentage of monthly collections, starting as low as 2.95%, with no separate setup fee. The rate is set by claim volume, specialty, and whether the practice needs credentialing support alongside standard billing.
Community Behavioral Health (CBH) Carve-Out Billing
Pennsylvania is one of fewer than a dozen states that carves Medicaid behavioral health out of physical health managed care entirely, and in Philadelphia that carve-out runs through Community Behavioral Health (CBH), the county’s dedicated behavioral health managed care organization. A physical-health HealthChoices MCO like Keystone First will not pay a mental health or substance-use claim, no matter how clean it is, because behavioral health simply isn’t part of that contract. Practices billing both physical and behavioral health services need separate credentialing with CBH, not just enrollment in Medicaid generally.
✔ Separate CBH credentialing and claims submission for behavioral health services
✔ Physical health (HealthChoices Southeast Zone) claims kept distinct from behavioral health claims
✔ Standard commercial billing for the rest of a practice’s patient panel
Academic Medical Center Referral Billing
Philadelphia has one of the highest concentrations of academic medical centers of any US city, Penn Medicine, Jefferson Health, Temple Health, and Drexel-affiliated systems among them, and independent specialty practices affiliated with or receiving referrals from these systems see a meaningful share of patients whose home coverage and referral chain need verification before treatment.
✔ Eligibility verification for academic-center referral patients
✔ Coordination with major health system referral networks
✔ Standard commercial and Medicaid billing for the rest of a practice’s patient panel
No-Fault (First Party Benefits) Billing for Philadelphia Practices
Pennsylvania is a “choice no-fault” state: every driver carries at least $5,000 in first-party medical benefits regardless of fault, though insurers must offer up to $100,000, and a driver’s full-tort or limited-tort election affects their legal rights but not the first-party medical benefit itself. Philadelphia’s traffic volume makes this a routine claim category for urgent care and orthopedic practices.
✔ First-party benefits (PIP) claims billed against the policy’s actual medical benefit limit
✔ Standard commercial and Medicaid billing for the rest of a practice’s patient panel
Medical Coding and Denial Management for Philadelphia Practices
A Philadelphia practice’s patient panel can include CBH behavioral health, HealthChoices physical health, academic referrals, and first-party benefit claims. Certified coders assign ICD-10-CM, CPT, and HCPCS Level II codes against whichever category applies. For denials, we investigate the root cause, correct and resubmit within the payer’s filing window, and track Pennsylvania’s prompt-pay requirements.
✔ ICD-10-CM, CPT, and HCPCS Level II coding by certified coders
✔ Root-cause denial review and resubmission
✔ Pennsylvania prompt-pay deadline tracking
✔ AR follow-up on aged and underpaid claims
Why Choose Techera Med Systems in Philadelphia
Coverage and Convenience
Philadelphia practices get the complete billing cycle from Techera Med Systems: eligibility verification, charge entry, coding, claims submission, denial management, and AR follow-up, priced at a percentage of monthly collections starting at 2.95%, with no separate setup fee.
Local and Regulatory Expertise
✔ CBH behavioral health carve-out billing — separate credentialing and claims routing handled correctly.
✔ Academic medical center referral verification — coverage checks for Philadelphia’s major health systems.
✔ First-party benefits (No-Fault) billing — claims billed against Pennsylvania’s actual policy limits.
✔ Pennsylvania prompt-pay tracking — claims tracked against the state’s payment deadlines.
In-House vs. Outsourced Billing
Philadelphia practices weighing in-house billing against outsourcing are weighing whether one person can keep CBH behavioral health claims separated correctly from HealthChoices physical health claims without a rejection teaching them the hard way.
| Factor | In-House Billing | Techera Med Systems |
|---|---|---|
|
CBH behavioral health carve-out routing |
Frequent source of flat-out rejected claims |
Credentialed and routed correctly from the start |
|
Academic-center referral verification |
Frequent source of unverified claims
|
Verified as a standard workflow
|
|
Staffing risk
|
Single point of failure
|
Dedicated revenue cycle team
|
|
Cost structure
|
Fixed salary regardless of collections
|
Percentage of collections, starting at 2.95%
|
Service Area & Coverage
We support practices across Philadelphia, including clinics near Penn Medicine, Jefferson Health, and Temple Health. This is a remote billing service; we don’t maintain a physical office in Philadelphia, and coverage is based on claims volume and specialty, not proximity to a branch location.
Frequently Asked Questions
How much does medical billing cost in Philadelphia?
Techera Med Systems charges a percentage of monthly collections, starting as low as 2.95%, based on claim volume and specialty.
What is CBH, and why does it matter for billing?
Community Behavioral Health is Philadelphia’s dedicated Medicaid behavioral health managed care organization. Pennsylvania carves behavioral health out of physical health HealthChoices plans entirely, so behavioral health claims need separate CBH credentialing.
Do you bill first-party (No-Fault) auto insurance claims?
Yes, against Pennsylvania’s first-party medical benefit structure, which carries a $5,000 minimum but can go up to $100,000 depending on the policy.
Do you offer medical billing for specific specialties in Philadelphia?
Yes, across more than 40 specialties. See our specialties page (https://techeramedsystems.com/specialties/) for the full list.
