Updated September 1, 2026
Verify Medicaid Pennsylvania eligibility in real time.
Medicaid Pennsylvania supports electronic real-time eligibility. Send the check to payer ID 236003113 and the full benefits picture comes back in seconds, before the patient sits down.
Also billed as: Pennsylvania Medicaid · Pennsylvania Medical Assistance
Seconds
The same Medicaid Pennsylvania check that takes 15 to 25 minutes on the phone. Ten patients tomorrow: ten checks, or three hours on hold.
3 billing names
Medicaid Pennsylvania shows up on cards under 3 names. Every one routes to payer ID 236003113, and so do 10 older payer IDs still printed on cards. No guessing which card this is.
42 Medicaid plans
verify in real time through Valian. One setup covers the whole Medicaid family, Medicaid Pennsylvania included.
From $39/mo
Per location, billed yearly. Found checks are billed once a month, $2.50 each and less as you run more. No seat fees, no processing fees.
The phone way
Call, hold, transcribe, repeat.
Verifying Medicaid Pennsylvania by phone means a menu, a hold queue, and 15 to 25 minutes per patient while someone at the desk reads benefits back by hand. Ten patients on tomorrow's schedule is half a workday on hold.
The real-time way
Payer ID 236003113, in seconds.
The same check, sent electronically. Sign in and run it for any patient in one click, and Valian flags the ones that need a human look.
| By phone | In Valian | |
|---|---|---|
| Time per patient | 15 to 25 minutes on hold | Seconds |
| When it happens | Day of, squeezed between patients | Any time before the visit, in one click |
| What you get | Notes scribbled while someone reads benefits aloud | The full breakdown, saved to the patient |
What a Medicaid Pennsylvania eligibility check returns
- Whether coverage is active, with plan and group details
- Deductible, and how much of it is already met this year
- Annual maximum, and how much of it is left to work with
- Coverage percentages by category: preventive, basic, major
- Frequency limits on cleanings, exams, and X-rays
- Waiting periods, where Medicaid Pennsylvania reports them electronically
Eligibility result
Sample data- Status
- Active
- Plan
- PPO · Group 8823
- Deductible
- $50 · $0 met
- Annual max
- $1,500 remaining
- Preventive
- 100%
- Basic
- 80%
- Major
- 50%
- Cleanings
- 2 / year
Returned in seconds · payer ID 236003113
How practices handle this today, in their own words
Verbatim from recorded calls to dental offices. Names withheld.
We call the insurance, or I go on their website and do it. Yeah, we manually do it.
We have a third party insurance verification team that does it for us. I’m not too sure, maybe like seven, ten minutes.
Our system does it, and the ones that are not set up for electronic, we do ourselves.
How getting set up works
Book a discovery call
A 15-minute call with our team: we show you a check and size your plan. Then you sign up from the link we send you: create the account, sign the agreement, and put a card on file.
Save your carriers and codes
Pick the insurance carriers you take and the codes you check.
Run a check in one click
Sign in, pick a patient and see their coverage in seconds before the visit, Medicaid Pennsylvania included. No hold music, no portal logins.
Under half an hour of your time all in. See how the software compares, how a real-time check works, or what outsourcing costs.
What Medicaid PA supports through our network
- Real-time eligibility (270/271)
- Yes, in seconds
- Enrollment for eligibility
- None, checks work day one
- Dental claims (837D)
- Yes
- Claim status (276/277)
- Yes
- Electronic remittance (835)
- Yes, after a multi-step enrollment, typically a few weeks
- Electronic funds transfer
- Not through our network
- Claim attachments
- Not through our network
Names and IDs this payer goes by
Medicaid Pennsylvania · Pennsylvania Medicaid · Pennsylvania Medical Assistance. Older cards may show payer ID 10165, 12008, 1491, 1605 and 5509. All of them route to payer ID 236003113.
Payer site: www.pa.gov/agencies/dhs/resources/medicaid
How to verify Medicaid Pennsylvania, step by step
Get the member ID and date of birth from the card or the patient.
Send the electronic eligibility request (a 270) to payer ID 236003113.
Read the response (the 271): status, deductible, max, percentages, frequencies.
Save the breakdown to the patient. With Valian, all four take one click and a few seconds.
Medicaid Pennsylvania runs Medicaid plans across Pennsylvania. Medicaid dental benefits change by state and by age, which is exactly what the check reads off the plan.
Medicaid Pennsylvania, for your front desk
Portal, from Medicaid Pennsylvania's own provider pages.
- Provider portal
- PROMISe™ Provider Portal
Source: Medicaid Pennsylvania, faq billing claims page. Checked September 19, 2026.
Medicaid Pennsylvania, quick answers
Does Medicaid Pennsylvania support real-time eligibility?
Yes. Eligibility checks to Medicaid Pennsylvania clear electronically in seconds through payer ID 236003113.
What payer ID do I use for Medicaid Pennsylvania?
236003113 for eligibility transactions. The same payer also appears on cards as Pennsylvania Medicaid, Pennsylvania Medical Assistance.
What does a check cost with Valian?
Plans from $39 a month per location, billed yearly, or from $49 month to month. Plus $2.50 or less per check we find — $0 when we can’t find the insurance. No setup fee and no seat fees. Sign in and run each check in one click before the visit.
Does Medicaid Pennsylvania require enrollment before I can check eligibility?
No. Eligibility checks work from day one, with no payer enrollment paperwork.
Which Medicaid Pennsylvania plans does this cover?
Medicaid Pennsylvania runs Medicaid plans in Pennsylvania. The eligibility check reads the specific plan on the patient's card, whichever program it belongs to.
Can I get Medicaid Pennsylvania remittances electronically?
Yes. Medicaid Pennsylvania sends electronic remittance advice (835) after a multi-step enrollment, typically a few weeks.
What if the patient's card shows a different Medicaid name?
Alternate billing names route to the same payer ID, 236003113. The same check covers them.
More questions about verifying Medicaid Pennsylvania? Schedule 15 minutes with us and bring your toughest plan.
Check any Medicaid Pennsylvania patient in one click, before they walk in.
Plans from $39 a month per location, billed yearly, or from $49 month to month. Plus $2.50 or less per check we find — $0 when we can’t find the insurance. No setup fee and no seat fees.
Book 15 minutes, demo or onboarding
Pick a time, then tell us on the form whether it is a demo or an onboarding call.
Other Pennsylvania dental payers
32 other payers operating in Pennsylvania also verify in real time, 10 of them with Medicaid plans.
- Aetna Better Health Pennsylvania23228
- AmeriHealth95044
- AmeriHealth Caritas Northeast77001
- AmeriHealth Caritas Pennsylvania22248
- Blue Shield of PennsylvaniaCB865
- Blue Shield of Pennsylvania - Dental PlusCBPA2
- CareFirst Blue Cross Blue Shield MarylandSB690
- CareFirst Blue Cross Blue Shield Maryland - Dental00580
- Central Pennsylvania Teamsters Health & Welfare FundTLU51
Medicaid plans in Pennsylvania: Aetna Better Health Pennsylvania, AmeriHealth Caritas Northeast, AmeriHealth Caritas Pennsylvania, CareFirst Blue Cross Blue Shield Maryland, Geisinger Health Plan, Health Partners Plans, and 4 more.
The Medicaid family in the network
42 Medicaid plans verify in real time through Valian.
- Verify Medicaid Alabama eligibility
- Verify Medicaid Alaska eligibility
- Verify Medicaid Arizona eligibility
- Verify Medicaid Arkansas eligibility
- Verify Medicaid California Medi-Cal eligibility
- Verify Medicaid Connecticut eligibility
- Verify Medicaid Delaware eligibility
- Verify Medicaid District of Columbia eligibility
- Verify Medicaid Florida eligibility
- Verify Medicaid Georgia eligibility
- Verify Medicaid Hawaii eligibility
- Verify Medicaid Idaho eligibility
Payer names and marks belong to their owners and identify the insurance company a practice can verify. Sample result shown for illustration; real results reflect the patient's actual plan. Payer capabilities can change between network updates.