Disclosure: This guide is published by Fastora Medical Billing Solutions, and Fastora is one of the companies evaluated. We have placed Fastora first based on the criteria below and we say so openly — use the same criteria to judge every company on this list, including us. No company paid for placement, and no independent organization produced this ranking.
Pennsylvania billing has a structural quirk that decides whether claims pay: most Medical Assistance coverage runs through HealthChoices managed care, but behavioral health is carved out into a separate program, Behavioral HealthChoices, administered county by county through its own managed care organizations. For the same patient, a physical health claim and a behavioral health claim go to two different payers — and a behavioral health claim sent to the physical health plan denies for wrong payer, however clean it is. Add a commercial market anchored by large regional plans, and your billing company needs Pennsylvania routing and enrollment discipline, not just generic claims processing. This guide compares seven companies that bill for Pennsylvania practices in 2026. If you want the service itself rather than a comparison, start with Fastora’s medical billing services in Pennsylvania.
How we evaluated these companies
- HealthChoices and Behavioral HealthChoices fluency — does the company route physical and behavioral health claims to the right plan and county program, or does it treat Pennsylvania Medicaid as one payer?
- Specialty coding depth — Pennsylvania demand concentrates in behavioral health, cardiology, therapy, geriatrics, and substance use treatment; coding has to match the specialty, not a generalist template.
- Denial and A/R work — who appeals, rebills, and chases aged receivables, versus who only reports them back to you?
- Enrollment and credentialing upkeep — lapsed revalidations and mismatched provider records deny claims before anyone reviews them; who keeps them current?
- Pricing clarity — is the model published, and does the quoted scope include credentialing, authorizations, and old A/R, or are those separate line items?
- Practice-size fit — a solo therapist, a multi-site group, and a hospital-owned network need different things from a billing partner.
The companies at a glance
| # | Company | Best for | Type |
|---|---|---|---|
| 1 | Fastora Medical Billing Solutions | Full-cycle billing with Behavioral HealthChoices routing handled up front | Billing service / RCM |
| 2 | Transcure | End-to-end RCM at a published flat rate | Billing service / RCM |
| 3 | Medwave Billing & Credentialing | Billing paired with credentialing and payer contract negotiation | Billing / credentialing / contracting |
| 4 | Mediclaim Inc | Philadelphia-area practices; long-established local firm, published starting rates | Billing service |
| 5 | Medical Revenue Associates | Full back office incl. patient statements and billing calls | Billing service |
| 6 | Nextus Billing Solutions | Behavioral-health-only billing with utilization review | Behavioral health RCM |
| 7 | TJ Billing | Chiropractic, PT, and podiatry specialty focus | Specialty billing service |
1. Fastora Medical Billing Solutions
Fastora is a remote billing partner for Pennsylvania practices — it has no Pennsylvania office, and its Pennsylvania work is built around the state’s managed-care mechanics. Routing comes first in its workflow: because behavioral health claims pay only when they reach the member’s county Behavioral HealthChoices program, the correct plan and county are confirmed at eligibility verification, not discovered after a wrong-payer denial. The service covers the full cycle — eligibility verification, coding, claims submission, denial management, A/R recovery, payment posting, and credentialing and enrollment support — including dedicated behavioral health billing services for the practices the carve-out affects most. Fastora also publishes its medical billing services beyond Pennsylvania for practices with locations in more than one state.
The company’s reported experience: 50+ active clients, 100+ physicians supported, and more than 5 years in medical billing and revenue cycle management. Pennsylvania practices are quoted either a percentage of collections or a flat monthly fee after a free billing assessment, and the scope is defined before signing.
Strengths: the Behavioral HealthChoices routing requirement is treated as an operational checkpoint, and the full cycle including A/R recovery sits in one service. Considerations: Fastora works with Pennsylvania practices remotely — practices wanting a local team on site should weigh that.
Best fit: independent and group practices, including behavioral health and substance use treatment providers, that want routing, coding, and denial work handled by one team.
2. Transcure
Transcure is a national revenue cycle company serving all 50 states, with a dedicated Pennsylvania service page. Its scope is end-to-end: eligibility verification, coding, claims submission, denial management, credentialing, and old A/R recovery, with an emphasis on scrubbing claims against payer rules before submission. Transcure publishes its pricing directly: a flat 5% of collections, with credentialing and old A/R recovery included in that rate. It reports working across more than 40 specialties.
Strengths: a published, all-in rate makes scope comparison straightforward, and the national operation brings broad specialty coverage. Considerations: confirm which team staffs your account, and ask how HealthChoices and Behavioral HealthChoices claims are routed for your specialty.
3. Medwave Billing & Credentialing
Medwave is based in Cranberry Township, in the Pittsburgh metropolitan area, and combines three services most companies keep separate: billing, credentialing, and payer contracting. Its credentialing team manages enrollment with Medicare, Medicaid, and commercial payers, including CAQH profile maintenance and recredentialing cycles. On the contracting side, Medwave reviews a practice’s existing payer agreements, identifies below-market rates and negotiates with payers directly. Its billing team handles charge capture, coding review, claim submission, payment posting, and denial management for independent physicians, group practices, allied health providers, and multi-specialty organizations, and the company states that its billing work is performed by its own staff rather than outsourced overseas.
Strengths: payer contract review and rate negotiation is a genuine differentiator — most billers work within whatever rates a practice already has. Considerations: the breadth cuts both ways; scope the engagement to what you need so you are not paying for unused contracting work.
4. Mediclaim Inc
Mediclaim is a Philadelphia billing company that has served the city’s medical community since 1990. Its published full-service rates start as low as 3.0% of collections, with no add-on fees and no binding contract. The service covers charge entry including patient demographics, payment posting, denial correction and resubmission, secondary and tertiary billing, patient billing with telephone support for patient questions, and follow-up on unpaid claims, with practice data accessible through an online portal. Mediclaim states that it processes claims within 48 hours of receipt. Its specialty experience includes podiatry, allergy, neurology, gastroenterology, pediatrics, pain management, and dermatology.
Strengths: a published starting rate, no binding contract, and three decades in one market. Considerations: the footprint is Philadelphia-centered — practices elsewhere in Pennsylvania should confirm how account communication and any in-person needs are handled.
5. Medical Revenue Associates
Medical Revenue Associates (MRA) is based in Bensalem, in Bucks County, and its founder’s medical billing work dates to 1984. The model is a full back office: the practice prepares its daily encounters and demographics, and MRA handles data entry, electronic claims submission, payment posting, denial and open-claim follow-up, patient statements, and patient billing phone calls. Credentialing is part of the offer, and MRA is a member of the HBMA. It serves physician practices in Pennsylvania and several other states, and it offers a free, no-obligation revenue audit to prospective clients.
Strengths: few companies on this list will field your patients’ billing calls as part of the standard service, and four decades in business counts for payer knowledge. Considerations: the focus is physician practices — hospitals, facilities, and very high-volume groups should confirm capacity and reporting depth before committing.
6. Nextus Billing Solutions
Nextus is a behavioral-health-only billing company with offices in Philadelphia and Boca Raton, Florida. It manages the revenue cycle for behavioral health and substance use treatment programs end to end: verification of benefits, claim submission and resubmission, utilization review, records requests to insurers, and collections follow-up. Utilization review is part of the standard workflow rather than an add-on, which matters for treatment programs whose authorizations decide whether care gets paid. Nextus positions its service for programs that are growing or short-staffed.
Strengths: specialty-only depth — every workflow is built for behavioral health levels of care, authorizations, and payer reviews. Considerations: that focus is the limit as well: general medical and surgical practices are outside its scope.
7. TJ Billing
TJ Billing is a small, woman-owned billing company in Lafayette Hill, outside Philadelphia, built around chiropractic billing — its founder’s background is in running a chiropractic practice — with physical therapy and podiatry billing also offered. The service covers claims billing plus authorizations and referrals, with client-visible tracking of accounts, invoicing, and payments. Its published materials emphasize the musculoskeletal claim types generalist billers often mishandle, including motor vehicle accident and workers’ compensation claims, and customizable service arrangements rather than a fixed package.
Strengths: a narrow specialty focus with first-hand practice-side experience is hard to replicate in a generalist firm. Considerations: the specialty range is deliberately narrow — practices outside chiropractic, therapy, and podiatry should look elsewhere on this list.
How to choose for your Pennsylvania practice
Start with your payer mix. If Medical Assistance is a meaningful share of your revenue, the deciding questions are operational: how does the company confirm the member’s HealthChoices plan, and — for any behavioral health services — the correct county Behavioral HealthChoices program, before the claim goes out? If commercial plans dominate, weight credentialing and contract rates instead; one company on this list renegotiates payer contracts, which matters more than a small rate difference. Then compare scope at the same definition — a lower percentage that excludes credentialing, authorizations, and old A/R is not cheaper than a higher one that includes them. Finally, match the company to your specialty and size: a behavioral-health-only firm, a chiropractic specialist, and a national platform are three different relationships.
Frequently asked questions
What makes Pennsylvania Medicaid billing different from other states?
Most Pennsylvania Medical Assistance coverage is delivered through managed care under HealthChoices, so physical health claims go to the member’s managed care plan rather than to the state. Behavioral health is carved into a separate program, Behavioral HealthChoices, run county by county through its own managed care organizations — so the correct payer for a behavioral health claim depends on the patient’s county, and a claim sent to the physical health plan denies for wrong payer even when the service is covered.
How much does it cost to outsource medical billing in Pennsylvania?
Most companies price either as a percentage of collections or as a flat monthly fee. Two companies on this list publish figures: a flat 5% of collections for end-to-end service, and full-service rates starting as low as 3.0%. Percentages are only comparable at equal scope: confirm whether credentialing, prior authorizations, patient statements, and old A/R recovery are inside the rate or billed separately. Fastora quotes a percentage of collections or a flat monthly fee after a free billing assessment.
Does my billing company need to be located in Pennsylvania?
No. Claims are filed electronically, and what matters is whether the company works Pennsylvania’s payer rules correctly — HealthChoices plan requirements, Behavioral HealthChoices county routing, and enrollment revalidation. A Pennsylvania office can help with local payer familiarity, but a remote company with disciplined routing and enrollment tracking will outperform a local one without it.
What should I ask a billing company about credentialing and enrollment?
Ask who owns enrollment maintenance after the initial setup, how revalidation dates are tracked, and what happens when a new provider joins your practice mid-contract. In Pennsylvania, a lapsed revalidation or a provider record that does not match the plan’s file turns otherwise clean claims into denials, so the answer should describe an ongoing process, not a setup task.
Can a new billing company take over our old accounts receivable?
Most full-service companies will work aged A/R as part of onboarding or as a defined add-on — several companies on this list include old A/R recovery in their published scope. Get the scope in writing: which aging buckets are included, how far back they will pursue, and whether recovery work is inside the standard rate or priced separately.
Will we have to change our EHR to outsource billing?
In most cases, no — billing services work within the EHR you already use, so changing billers does not mean changing systems. Name your platform up front, and ask how charges and remittances flow between your office and theirs.
Conclusion
Pennsylvania rewards billing companies that get routing and enrollment right before the claim is judged on anything else. Compare the seven companies above on the criteria that match your payer mix — HealthChoices and Behavioral HealthChoices discipline, specialty coding depth, real denial and A/R work, and a pricing scope you can verify line by line.
Looking for a more reliable medical billing partner? Fastora Medical Billing Solutions provides medical billing and revenue cycle management support for Pennsylvania practices. Request your free initial billing audit to discuss your practice’s billing workflow and identify potential areas for improvement.
Sources: service descriptions are drawn from each company’s own published materials (Transcure, Medwave Billing & Credentialing, Mediclaim Inc, Medical Revenue Associates, Nextus Billing Solutions, TJ Billing), reviewed October 2026. Pennsylvania Medicaid managed-care facts are drawn from Pennsylvania Department of Human Services HealthChoices program materials. Fastora company figures are company-reported.
