Medicaid Payment Policy Update for Inpatient Professional Claims

Date: 11/26/18

Thank you for your continued partnership with PA Health & Wellness. We value and appreciate the care you give to our Participants. 

We are updating our Medicaid payment policies for inpatient professional claims. Inpatient professional claims will deny if the inpatient stay was not medically necessary.

In order to ensure that inpatient professional claims are paid, please verify that the services rendered meet the requirements for medical necessity. If you have any questions about this policy, please contact Provider Services at 1-844-626-6813.