Dental insurance verification in Pennsylvania.
33 payers operating in Pennsylvania support real-time dental eligibility, on top of the 30 nationwide carriers. Every one of them verifies in seconds, with the full benefits breakdown, before the patient sits down. Valian's dental eligibility verification covers every payer listed below.
Pennsylvania payers with real-time eligibility
Aetna Better Health Pennsylvania
AmeriHealth
AmeriHealth Caritas Northeast
AmeriHealth Caritas Pennsylvania
Blue Shield of Pennsylvania
Blue Shield of Pennsylvania - Dental Plus
CareFirst Blue Cross Blue Shield Maryland- CareFirst Blue Cross Blue Shield Maryland - Dental
Central Pennsylvania Teamsters Health & Welfare Fund
Clover Health
Community Care Behavioral Health Organization
Delta Dental of Maryland
Delta Dental of Pennsylvania
Devoted Health
Geisinger Health Plan
Health Partners Plans
HealthSpring
Highmark Wholecare
Highmark Wholecare Medicare Assured
Horizon Blue Cross and Blue Shield of New Jersey
Independence Administrators
Independence Blue Cross
Jefferson Health Plans
Keystone First CHIP
Keystone First VIP Choice
Luminare Health
MCNA Dental
Medicaid Pennsylvania
MVP Health Care
Oscar Health
Sana Benefits
TRICARE East
UPMC Health Plan
Nationwide carriers like Aetna, Cigna, UnitedHealthcare Dental, Humana and ASA GEHA verify in Pennsylvania too. browse the full directory.
Pennsylvania payers by plan type
11
Commercial payers
11
Medicaid payers
11
Medicare payers
1
TRICARE payer
23 of the 33 Pennsylvania payers list the programs they run: 11 run Commercial plans, 11 run Medicaid plans, 11 run Medicare plans and 1 runs TRICARE plans. Some run more than one. The other 10 do not list one.
By line of coverage, 8 cover dental only, 25 also cover medical and 14 also cover vision. Whatever the program, the eligibility check reads the specific plan on the patient's card.
11 payers run Medicaid plans in Pennsylvania
- Aetna Better Health Pennsylvania, payer ID 23228
- AmeriHealth Caritas Northeast, payer ID 77001
- AmeriHealth Caritas Pennsylvania, payer ID 22248
- CareFirst Blue Cross Blue Shield Maryland, payer ID SB690
- Geisinger Health Plan, payer ID 75273
- Health Partners Plans, payer ID HPPA
- Highmark Wholecare, payer ID 96938
- Highmark Wholecare Medicare Assured, payer ID 60550
- Keystone First VIP Choice, payer ID 77741
- Medicaid Pennsylvania, payer ID 236003113
- MVP Health Care, payer ID 14165
Enrollment with Pennsylvania payers
All 33 Pennsylvania payers run real-time eligibility with no enrollment step, so checks work from the first day.
On the payment side, 26 of the 33 send electronic remittance advice (835) only after enrollment and 7 do not offer it electronically. 20 use a one-click enrollment and 6 need a multi-step one. Typical enrollment time: a few weeks for 15, within hours for 5, over four weeks for 4 and a few days for 2.
For claims, 8 accept dental claims (837D) electronically and 20 answer claim status requests (276/277). Eligibility checks do not wait on any of it, so you can verify a patient before any of that paperwork is done.
How to verify a Pennsylvania patient's dental coverage
- Step 1
Gather the basics.
Get the member ID from the insurance card, plus the patient's full name and date of birth.
- Step 2
Pick the payer.
Match the card to one of the 33 Pennsylvania payers above or to a nationwide carrier. Between them, the Pennsylvania payers go by 112 billing names and 165 alternate payer IDs, so the card may not match the list word for word.
- Step 3
Run the check.
The eligibility request goes to the payer electronically and the answer comes back in real time, with no enrollment needed first for any of the 33.
- Step 4
Read the benefits breakdown.
Look at active status, deductible, annual maximum, coverage percentages and frequency limits before the patient sits down.
With Valian's dental insurance eligibility verification, your team runs all four steps from one screen for every payer on this page.
Pennsylvania dental payers, quick answers
How many dental payers in Pennsylvania support real-time eligibility?
33 payers operating in Pennsylvania support real-time dental eligibility, and each one is listed on this page with its own payer page. Nationwide carriers are counted separately.
Which Pennsylvania Medicaid dental plans can be verified in real time?
Aetna Better Health Pennsylvania (payer ID 23228), AmeriHealth Caritas Northeast (payer ID 77001), AmeriHealth Caritas Pennsylvania (payer ID 22248), CareFirst Blue Cross Blue Shield Maryland (payer ID SB690), Geisinger Health Plan (payer ID 75273), Health Partners Plans (payer ID HPPA), Highmark Wholecare (payer ID 96938), Highmark Wholecare Medicare Assured (payer ID 60550), Keystone First VIP Choice (payer ID 77741), Medicaid Pennsylvania (payer ID 236003113) and MVP Health Care (payer ID 14165). These 11 payers run Medicaid plans in Pennsylvania and support real-time eligibility.
Do nationwide carriers verify in Pennsylvania?
Yes. 30 nationwide carriers verify for patients in Pennsylvania as well, including Aetna, Cigna, UnitedHealthcare Dental, Humana and ASA GEHA. They are in addition to the 33 payers that operate in Pennsylvania.
Do Pennsylvania payers require enrollment before eligibility checks?
No. All 33 Pennsylvania payers run real-time eligibility with no enrollment step. Enrollment comes up on the payment side instead: 26 of them require it before sending electronic remittance advice (835).
Check any 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.