Pennsylvania dental billing runs on HealthChoices MCO protocols and state-specific Medicaid mandates out-of-state vendors consistently misread. TransDontics’s 1,100+ Pennsylvania-credentialed specialists manage your complete revenue cycle from eligibility verification to payment posting.
Pennsylvania dental billing runs on HealthChoices MCO protocols and state-specific Medicaid mandates out-of-state vendors consistently misread. TransDontics’s 1,100+ Pennsylvania-credentialed specialists manage your complete revenue cycle from eligibility verification to payment posting.
Pennsylvania's Dual-Track MA Dental System
Benefit Limit Exceptions: Pennsylvania's Hidden Denial Driver
Multi-Location Credentialing in Pennsylvania's DSO Market
HIPAA and Pennsylvania’s Health Privacy Protections
TransDontics’s 1,100+ in-house dental billing specialists are supported by RPA automation engineered for Pennsylvania’s dental billing environment. Every process is designed around the actual payer rules, fee schedules, and documentation standards your claims will face.
Most billing companies are either fully manual or heavily automated. TransDontics deploys both. Our RPA handles high-volume repetitive tasks while our specialists manage every decision requiring clinical or contractual judgment. That combination drives our first-pass claim rate to 98%.
Every payment is reconciled against your contracted rate, line by line, across every payer. When Delta Dental of Pennsylvania or any commercial carrier pays below the agreed fee on a specific plan type, we flag it and file the appeal within 14 days. Most practices only catch outright denials. We go further.
Before every MA dental claim, we confirm FFS or HealthChoices enrollment, identify the correct MCO and dental administrator, and route accordingly. Submitting a HealthChoices claim through PROMISe™ or a FFS claim through an MCO portal is an automatic denial. We route every claim correctly.
Claims submitted within 48 hours of receipt. No setup fee, no monthly minimum, no long-term contract, no hidden costs. Our fee is a straightforward percentage of what we successfully collect. We only earn when you get paid, which means our incentives are perfectly aligned with yours from day one.
Expert CDT coding, clean claim submission, and aggressive denial management by specialty-certified billers. 98% first-pass clean claim rate.
No claim goes 48 hours without follow-up. We pursue every outstanding balance across all payers until it is paid, appealed or written off.
Get in-network faster. We handle all payer paperwork, CAQH maintenance, renewals, and compliance tracking so you start seeing insured patients.
Full revenue cycle coverage from patient registration to final payment. We manage all claims, close every gap, and maximize your collections.
Strategic oversight of your practice’s operational and financial performance. We track collections, payer mix, and productivity metrics
Complete front office billing support covering patient billing inquiries, insurance comms, prior auth, and appointment-linked verification.
HIPAA-compliant dental transcription delivered fast and accurately. Clinical notes, procedure documentation, and patient records are transcribed.
We review your last 12 months, find your top 3 revenue leaks, and show you exactly what we fix. Practices often discover recoverable revenue.
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An in-house biller knows your practice, not PROMISe™ versus HealthChoices MCO routing, BLE pre-authorization requirements, or crown claim documentation issues. Turnover resets that knowledge. Ours doesn’t.
Most billing companies don’t track BLE pre-authorization status, reconcile EOBs against contracted rates, or manage new provider enrollment across PROMISe™ and active HealthChoices MCO. TransDontics does all of it.
Most billing companies are a service. TransDontics is a system: RPA catching what humans miss at volume, experienced billers catching what automation cannot judge. The result is a first-pass acceptance rate of 98%.
Three steps. No disruption. No risk.
We connect directly to Dentrix, Eaglesoft, or your existing PMS. No migration, no new systems, no disruption.
Three steps. No disruption. No risk.
We review your claims, A/R, and denial patterns at zero cost. Most practices find 5–10% in hidden revenue leakage.
We connect directly to Dentrix, Eaglesoft, or your existing PMS. No migration, no new systems, no disruption.
We don’t publish named case studies because most clients prefer to keep billing performance private. What we can share is what the numbers look like across practices with comparable payer profiles.
Based on aggregated results across dental practices in comparable payer environments.
| Metric | Before TransDontics | After TransDontics |
|---|---|---|
| Average Denial Rate | 8–12% | Under 2.3% |
| First-Pass Clean Claim Rate | 70–80% | 98% |
| A/R Over 90 Days | 30–40% of Total AR | Reduced by 30%+ |
| Average A/R Resolution | 45+ Days | 18–25 Days |
| Claim Turnaround | 3–5 Days | 48 Hours |
| Revenue Growth (120 days) | Baseline | 5–12% Increase |
A Philadelphia suburbs practice came to us with a 10% denial rate, 35% of A/R past 90 days, and HealthChoices claims submitted through PROMISe™ instead of the patient’s MCO dental administrator with front desk spending 2–3 hours daily on billing follow-up.
Our specialists know every Pennsylvania payer’s rules and appeal processes. National billing companies confuse PROMISe™ with HealthChoices, miss BLE requirements, and overlook Highmark’s United Concordia routing. We don’t.
MA FFS dental claims submit through PROMISe™ with BLE approval required for crowns, root canals, and dentures beyond first set; 180-day timely filing strictly enforced.
Five zones, six active MCOs with independent portals, prior auth thresholds, and timely filing windows; providers must credential separately with each MCO’s dental program.
Dominant Western and Northeastern PA carrier with dental benefits routing through United Concordia’s portal, not Highmark’s; practices submitting through the wrong portal generate systematic denials.
Dominant commercial carrier across Philadelphia and four surrounding counties with its own portal and submission requirements entirely separate from IBX medical claims.
Independent BCBS licensee serving 21 central Pennsylvania counties with PPO and DHMO plans carrying distinct network, prior authorization, and fee schedule requirements.
PPO and DeltaCare USA DHMO plans across employer and individual markets; reimbursement differs across plan types with every EOB reconciled against contracted rates.
Both a HealthChoices MCO and commercial health plan across Central and Northeastern PA; product type identified at eligibility with HealthChoices and commercial routed through entirely different workflows.
Dental administrator for Highmark Blue Edge Dental plans statewide plus its own commercial plans and FEDVIP federal coverage, all product lines billed including the Highmark network relationship.
TransDontics bills Pennsylvania claims daily, knowing PROMISe™ FFS and HealthChoices are entirely different workflows, BLE documentation shifts by program type, and MCO mix varies by county. Demonstrated on every claim we touch.
Every Pennsylvania practice qualifies. If your city isn’t listed, it’s coming. Reach out now and we’ll onboard your practice without delay.
Every state has its own payer rules, Medicaid structure, and billing landmines. TransDontics expertly navigates all of them.
Pennsylvania practices carry HIPAA obligations alongside 49 Pa. Code §33.209 requiring records retained five years from last dental entry with accurate documentation of every service and provider. TransDontics is independently HIPAA certified and AICPA SOC 2 Type II compliant.
All patient data is encrypted end-to-end, satisfying HIPAA Security Rule technical safeguards and Pennsylvania’s patient records privacy requirements. Every data transmission meets the highest applicable standard, not just the minimum.
Only credentialed TransDontics personnel can access your practice data, eliminating the internal access vulnerabilities that turn in-house billing into a compliance liability most Pennsylvania practice owners don’t realize they are carrying until it is too late.
Our AICPA SOC 2 Type II certification is independently audited and renewed annually. Everything is documented and third-party verified. Your Pennsylvania practice’s liability exposure is measurably reduced from day one of our partnership.
Customized billing solutions based on your specialty
In-house billing looks cheaper on paper. It rarely is. Between staffing overhead, turnover, training costs, and the revenue lost to unworked BLE denials and MCO routing errors, most Pennsylvania practices are spending far more and collecting far less. TransDontics’s fee is a percentage of what you actually collect. That is the whole model.
Average Pennsylvania salary
Our Complimentary audit covers denied claims, MCO routing errors, and underpayments, no obligation, no pitch.
RPA handles volume tasks automatically and continuously: eligibility checks, FFS vs. MCO enrollment determination, BLE status verification, claim scrubbing, and payment posting. Billing specialists handle what requires judgment: BLE documentation review, appeals, EOB reconciliation, MCO credentialing coordination, and payer escalations. The combination is what keeps the first-pass rate at 98%. Either layer alone does not achieve that.
Denied claims. Aging A/R. Missed BLE pre-authorizations. MCO claims routed to the wrong portal. That is your uncollected money. TransDontics recovers it. Most Pennsylvania practices find 5–10% in hidden leakage. Start with a complimentary revenue audit. We review your current claims, A/R aging, and denial patterns at no cost and no commitment.
No setup fee. No monthly minimum.
Cancel anytime.
Response within 24 hours.
Pay only a percentage of what we collect for you
