Prior Authorization in Pennsylvania
Soft Home Global provides authorizations submitted ahead of the date of service and chased to a decision for Pennsylvania practices and billing companies at $1,900 per seat per month. Full time, worked during Pennsylvania business hours, inside your own system.
What is specific to Pennsylvania
Pennsylvania Medical Assistance operates alongside HealthChoices managed care plans.
Pennsylvania’s Medicaid programme is PA Medical Assistance. Practices with a meaningful PA Medical Assistance mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
What a prior authorization seat does in Pennsylvania
Submitted before the date of service and chased through the payer's decision window.
An authorisation found after the visit is a write-off, not a denial to appeal. In Pennsylvania the work is submitting ahead of scheduling and chasing the decision, against a payment clock that starts only once a clean claim lands.
- Authorizations submitted ahead of scheduling, not after
- Status chased rather than waited on
- Peer-to-peer reviews scheduled when required
- Clinical documentation gathered before submission
- Expiring authorizations flagged before they lapse
- Worked during Pennsylvania business hours, not queued overnight
For the statute behind all of this — Pennsylvania’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Pennsylvania billing page.
Working Pennsylvania hours
Pennsylvania runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Pennsylvania hours and nobody else’s.
What it costs in Pennsylvania
$1,900
Per seat, per month, in US dollars — $22,800 a year for one full-time person, forty hours a week, on Pennsylvania hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Pennsylvania run $1,500 to $2,500; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Pennsylvania
About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.
Questions
Do you work with Pennsylvania practices?
Yes. Pennsylvania accounts are worked during Pennsylvania office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Pennsylvania?
Pennsylvania Medical Assistance operates alongside HealthChoices managed care plans.
How long do we have to file a PA Medical Assistance claim?
180 days from the date of service (original invoice); 365 days to resubmit, measured from the date the services were rendered. A rejected original claim or an adjustment must be received within 365 days of the date of service. Past that date a claim is not late, it is unpayable, and no appeal recovers it. Source: 55 Pa. Code § 1101.68 — Invoicing for services.
When does a Pennsylvania payer have to pay a clean claim?
45 days from receipt of a clean claim, with no electronic-vs-paper distinction — the same 45 days applies either way. Act 68 / 40 P.S. 991.2166, implemented at 31 Pa. Code 154.18. Interest is added to late clean claims and must itself be paid within 30 days of the claim payment. A claim sitting past that is not merely late, it is late against a statute, and the follow-up call changes from "when might this be paid" to "this passed your statutory window on a specific date".
How much does prior authorization cost in Pennsylvania?
$1,900 per seat per month — $22,800 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Pennsylvania queue?
Pennsylvania is on Eastern time, 10 hours behind Rawalpindi. The shift here runs 7pm to 3am so your seat is at a desk for your full working day, shifting to 6pm to 2am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle PA Medical Assistance as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. PA Medical Assistance has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
What is the minimum commitment, and how quickly can somebody start?
One seat for one month, cancellable on thirty days notice, and about a week from a signed agreement to a person working your queue. The week of training is not billed. The steps are at softhomeglobal.com/how-it-works.
Is our patient data safe offshore?
A Business Associate Agreement is signed before anyone has access, and the work happens in your own system under a login you issue, so every action is attributable to a person in your audit trail. The controls are listed at softhomeglobal.com/security.
Next step
One seat on your Pennsylvania work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com