Dermatology billing in Pennsylvania

The complete process

How we bill a Pennsylvania dermatology claim, end to end.

1. Step 01

   Eligibility & benefits, before the visit

   Every scheduled patient is verified 48–72 hours ahead against the state's Medicaid plan, Medicare Advantage product, or commercial plan — including derm-specific benefit limits and prior-auth flags for biologics and phototherapy.

2. Step 02

   Charge capture from the derm note

   Certified derm coders read the operative and pathology notes, not a superbill checkbox. Lesion counts, excision measurements, Mohs stages, repairs, and E/M with modifier 25 are coded exactly as documented.

3. Step 03

   Pre-bill scrub against local rules

   Claims pass a state-level edit set built on the MAC's LCDs plus each in-state payer's quirks before they ever leave — NCCI bundling, frequency limits, POS accuracy, and medical-necessity narratives.

4. Step 04

   Clean submission & payer tracking

   Daily electronic submission with acknowledgment reconciliation. Nothing sits unbilled past five days, and prompt-pay clocks are tracked so late payers get chased with interest where state law allows.

5. Step 05

   Denials, appeals & underpayments

   Every denial is worked within 48 hours with a root-cause code. Appeals use state- and payer-specific templates, and payments are reconciled line-by-line against your contracted fee schedule.

6. Step 06

   Monthly reporting with your manager

   A named account manager reviews clean-claim rate, days in A/R, denial categories, and provider-level productivity with you — plus what changed in your state's rules that month.