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 under a second, before the patient sits down.
Also billed as: Pennsylvania Medicaid · Pennsylvania Medical Assistance
Under 1 second
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.
First month free
Then $2.50 a check, only when you run one. No seat fees, no platform fee, no contract. Cancel any time.
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, under a second.
The same check, sent electronically. Valian runs it automatically for every patient on the schedule before the day starts, and flags the ones that need a human look.
| By phone | In Valian | |
|---|---|---|
| Time per patient | 15 to 25 minutes on hold | Under a second |
| When it happens | Day of, squeezed between patients | Before the day starts, automatically |
| 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 under a second · 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
Sign up
About ten minutes: create the account, sign the agreement, and your free first month starts.
Connect your system
We connect your practice management software with your office manager. Open Dental, Dentrix, Eaglesoft, and more.
Checks run themselves
Every patient on the schedule gets verified automatically before their visit, Medicaid Pennsylvania included. Your team just reads the results.
Under half an hour of your time all in. See the full walkthrough on the insurance verification page.
What Medicaid PA supports electronically
- Real-time eligibility (270/271)
- Yes, under a second
- 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 offered electronically
- Claim attachments
- Not offered electronically
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. Valian does all four automatically, before every visit.
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, quick answers
Does Medicaid Pennsylvania support real-time eligibility?
Yes. Eligibility checks to Medicaid Pennsylvania clear electronically in under a second 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?
$2.50 per verification, run automatically before every appointment. Your first month is free, with no contract and no seat fees.
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 check resolves them automatically.
More questions about verifying Medicaid Pennsylvania? Schedule 15 minutes with us and bring your toughest plan.
Every Medicaid Pennsylvania patient, verified before they walk in.
First month free, then $2.50 a check. No seat fees, no platform fee, no contract.
Book 15 minutes, demo or onboarding
Pick a time, then tell us on the form whether it is a demo or an onboarding call.
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.