Shoreline Healthcare Technologies is a proud Maine-based company that offers end to end revenue cycle management services to physicians and Medical billing companies  in Pennsylvania. Our goal is to help them manage their business in a way where they can focus on patient care and operations, not paperwork! By providing great services at reduced costs, we have been able to keep our customers since our inception in 2015.Explore our case studies to see how we’ve helped practices overcome complex billing challenges and improve cash flow.

As a medical billing outsourcing company, we have helped our clients grow their business by providing them with the resources they need to succeed while maintaining a competitive edge in today’s industry. We offer timesaving, cost-effective revenue cycle management services to your Pennsylvania-based practice. Ready to outsource your billing needs? We’ll guide you through your receivable account to make sure that your claims are paid.

Pennsylvania Billing Challenges we solve

PROMISe System Complexity and Legacy Constraints

The PROMISe is the Pennsylvania’s core Medicaid billing platform, which is one of the most rigid Medicaid systems in the country. Hence claims formatting rules are challenging with minor data mismatches triggering rejections. They have limited real-time edits causing providers to discover the issues only after submission, also batch claim corrections often require full resubmission rather than partial edits. As a result, providers experience higher rejection rates. We at Shoreline Healthcare Technologies have built a PROMISe-ready claim workflow with correct provider identifiers, service location logic, taxonomy sequencing, NPI/PROMISe ID alignment, and line-level data consistency. Also, our pre-submission claim scrubbing + payer-rule checks helps to catch the small formatting/data issues that might cause rejections. We position this as part of our full-cycle RCM and denial prevention approach, thereby increasing the cash flow. With Shoreline you have Fewer “returned”/rejected claims = fewer resubmission cycles = faster first-pass payment.

Faster denial turnaround with root-cause fixations

Appealing for a denied Medicaid claim in Pennsylvania is notably time-consuming as PROMISe appeals differ from MCO appeals in format and submission method, the supporting documentation standards varies by payer, also the response timelines are longer than the national Medicaid average and providers are often required to resubmit the entire claim instead of correcting them. This increases the AR days and administrative costs. Shoreline operates a dedicated denial management workflow that analyze the root cause of the denial, correct it, resubmit/appeal the corrections, and track it continuously until closure. We have also built a root-cause prevention analytics to prevent the occurrence of the same denial across the clinicians/locations. This shortens the denial rates and fixes the write-offs.

Actionable RCM Intelligence That Accelerates Cash Flow

Shoreline Healthcare Technologies provides real-time, decision-ready RCM insights that go beyond the static month-end reports. With our real time dashboards organizations can gain daily visibility into their claim status, denial trends, payer-specific behaviors, and A/R aging thereby allowing the billing teams to identify the issues early and take corrective action before the revenue is delayed. We transform raw billing data into clear, actionable intelligence, that helps providers to reduce the avoidable denials, prioritize high-impact follow-ups, and make the cash to flow consistently.

We at Shoreline Healthcare Technologies provide personalized support tailored to the unique needs of Pennsylvania providers. Our team of experts understands the intricacies of the Pennsylvania billing landscape and offers guidance to help practices navigate these challenges effectively with our cloud-based RCM solutions for an optimized Revenue Cycle Management.

Medical Billing Resources for Pennsylvania

Comprehensive resources specifically designed for Medicaid Providers to navigate the state’s complex Billing Landscape.

Medicaid Billing Guide

A Complete guide covering all billing requirements, policy updates and compliance standards.

Behavioral & Mental Health Billing rules and guidelines

Specialized billing guidelines and documentation procedures for behavioral health programs.

Revenue Cycle Optimization

Best Practices and Strategies to improve cash flow and reduce denials.

Telehealth and Remote patient Monitoring in Pennsylvania

Pennsylvania’s telehealth and RPM guidelines and regulations.

Serving Healthcare Providers Across Pennsylvania

From Adams to York, we provide comprehensive medical billing services across all 67 Pennsylvania counties.

Southeast:

Bucks, Chester, Delaware, Montgomery, Philadelphia

Lehigh Valley:

Lehigh, Northampton

Northeast:

Bradford, Carbon, Lackawanna, Luzerne, Monroe, Pike, Schuylkill, Sullivan, Susquehanna, Wayne, Wyoming

South Central:

Adams, Berks, Cumberland, Dauphin, Franklin, Juniata, Lancaster, Lebanon, Mifflin, Perry, Snyder, Union, York

Central & North Central:

Cameron, Centre, Clearfield, Clinton, Columbia, Elk, Jefferson, Lycoming, McKean, Montour, Northumberland, Potter, Tioga

Southwest:

Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Fayette, Fulton, Greene, Huntingdon, Indiana, Somerset, Washington, Westmoreland

Northwest:

Clarion, Crawford, Erie, Forest, Lawrence, Mercer, Venango, Warren

Medical Billing Glossary

Essential Terms for Understanding the Pennsylvania’s Medical Billing Landscape

ACCESS Card

It is the benefits card issued to the individuals enrolled in Medicaid and other assistance programs. It is used to access healthcare services, prescription drugs, and additional state-supported benefits. For providers, the ACCESS Card helps to verify the patient’s eligibility and confirm the active status of their Medicaid coverage at the time of service.

Community HealthChoices (CHC)

The managed care program in the state of Pennsylvania that provides the long-term services and supports to eligible seniors and adults with physical disabilities. It integrates physical health services with long-term care, and follows MCO-specific authorization, billing, and encounter submission rules.

HealthChoices

It is the mandatory Medicaid managed care program in Pennsylvania through which most of the Medicaid beneficiaries receive their healthcare services.

PA Health and Wellness

A Managed Care Organization (MCO) that participates in the Pennsylvania’s health plans like HealthChoices and Community HealthChoices. They have plan-specific credentialing, authorization, billing, and timely filing rules for submitting the Medicaid claims.

Provider Reimbursement and Operations Management Information System (PROMISe)

The official claims processing and provider enrollment system in the state of Pennsylvania that manages the provider enrollment, eligibility verification, claims submission, payment processing, and remittance advice.

Testimonials

My first time in solo practice I was very concerned about my ability to manage "the business side" of medicine. The personalized care and guidance this group provided to me and my staff were really a life saver. They always had quick turnaround on any questions I sent in, and were very knowledgeable for problem solving on the fly! I never feel like just a number, as I might have with a large corporation.

★ ★ ★ ★ ★

Family Medicine Centre in Maine

“We use Shoreline Medical Billing for all our billing needs, the support is second to none! They are always up to date with coding updates which helps to ensure timely billings and prompt payments. I highly recommend Shoreline Medical Billing for your billing needs.”

★ ★ ★ ★ ★

Nephrology Group in New Hampshire

I have been using Shoreline Medical Billing for almost 2 years, and I could not be more pleased with their service. They really care about my business. With all the complexities of medical billing, we needed a professional partner to help us. Shoreline delivered.

★ ★ ★ ★ ★

Pain Management in New Jersey

We switched to Shoreline Medical Billing. Our claims are getting paid, and we are getting friendly, knowledgeable service. We highly recommend Shoreline.

★ ★ ★ ★ ★

Internal Medicine & Nephrology in Georgia

I’m a small pediatric OT practice and have been with Shoreline for several years now. They have made it so easy for me to keep my focus on patient care by being so knowledgeable and so efficient with all aspects of my billing. When I do have questions, they are always available and able to help quickly. Couldn’t be happier!

★ ★ ★ ★ ★

Peds OT Clinic in Maine

Thanks so much for working so hard to help my company:) It sound cheesy, but having a biller I could trust changed my life by giving me the headspace/time to focus on clinical work, scale my business and sleep better at night. I've had quite a few people ask about you on Facebook Messenger from my posts. Overall, the feedback I've heard back from everyone is that you guys are very responsive and helpful.

★ ★ ★ ★ ★

Nurse Practitioner Group in Washington

Hi, following up on our conversation about Shoreline. I did let them know that I had some concerns and they were very understanding. They have been very responsive and proactive in their billing process, reports and communication. It has been very good. Thank for recommending them.

★ ★ ★ ★ ★

Nurse practitioner in Delaware

Before Shoreline, billing was a constant headache. Now, our reimbursements are faster, and I’m no longer chasing unpaid claims. Their team handles everything so efficiently, it’s one less thing I need to worry about.

★ ★ ★ ★ ★

🩺 Services	📍Pennsylvania Specialization	📈 Typical Improvement	⏱️ Turnaround Time
End-to-End Medical Billing	Full alignment with Pennsylvania Medicaid billing rules, PROMISe edits, and HealthChoices MCO requirements	25–40% reduction in denial rates with faster reimbursement cycles.	Claims submitted within 24–48 hours
Eligibility & Coverage Verification	Daily eligibility checks across FFS and HealthChoices plans; detection of retroactive eligibility and coverage flips.	15–30% drop in eligibility-related denials	Instant/ Within 24 hours
Prior Authorization Management	Plan and county-specific PA handling for behavioral health, waiver, and specialty services	40–60% reduction in PA-related denials	3–5 business days
Provider Enrollment & Revalidation	PROMISe enrollment, revalidation tracking, and synchronization with MCO credentialing.	Prevents payment holds and enrollment-related denials	30–90 days (payer dependent)
Claims Scrubbing & Submission	PROMISe-specific front-end edits, validation, and MCO-specific rule checks	Higher clean-claim rate (up to 98%)	Same or next business day
Denial Management	AI based tools to track and flag denial codes and root-cause analysis tailored for Medicaid claim categories, identifies high-risk categories and automate resubmissions.	Reduce rate of denial by 75% and with quicker appeals.	7–14 days for backlog cleanup; ongoing daily follow-up
Patient Statements & Follow-Up	Communicate with patients and give Explanation of Benefits (EOBs). Includes text/email payment reminders and online payment options.	Reduces overdue balances and increases the collection rates.	1-2 weeks
Audit & Compliance Support	Conducts Audit Review and mock audits, including documentation, encounter verification, and claim reconciliation.	Minimizes risk of penalties and supports successful audits.	Ongoing, depending on audit schedule

The Best Medical Billing Company in Pennsylvania - Shoreline

Best In the Industry

Pennsylvania Billing Challenges we solve

PROMISe System Complexity and Legacy Constraints

Faster denial turnaround with root-cause fixations

Actionable RCM Intelligence That Accelerates Cash Flow

Comprehensive Medical Billing Services for Pennsylvania

Medical Billing Resources for Pennsylvania

Medicaid Billing Guide

Behavioral & Mental Health Billing rules and guidelines

Revenue Cycle Optimization

Telehealth and Remote patient Monitoring in Pennsylvania

Serving Healthcare Providers Across Pennsylvania

Southeast:

Lehigh Valley:

Northeast:

South Central:

Central & North Central:

Southwest:

Northwest:

Savings Estimation Calculator

Frequently Asked Questions

Q1. How is HealthChoices different from the regular fee-for-service programs?

Q2. How does Shoreline manage HealthChoices MCO complexity?

Q3. How does Shoreline prioritize A/R follow-up for Medicaid claims?

Q4. What are the initial processes that Shoreline does on onboarding?

Q5. What are the factors that influences the process of onboarding?

Q6. How can Shoreline Healthcare Technologies help providers in Pennsylvania?

Compliance & Certifications

HIPAA Compliant

AAPC Certified

Pennsylvania Licensed

Medical Billing Glossary

ACCESS Card

Community HealthChoices (CHC)

HealthChoices

PA Health and Wellness

Provider Reimbursement and Operations Management Information System (PROMISe)

Our Services

Testimonials

Family Medicine Centre in Maine

Nephrology Group in New Hampshire

Pain Management in New Jersey

Internal Medicine & Nephrology in Georgia

Peds OT Clinic in Maine

Nurse Practitioner Group in Washington

Nurse practitioner in Delaware

Internal Medicine in Arizona

We Care

Ready to Optimize Your Medical Billing?

Get Your Free Consultation

Contact Information

Why work with us?