MedicaidAdministrativeMedium impact
MAB 991808
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
May 25, 2018
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance updated the 180-day exception process for late claim submissions. Claims must still be submitted within 180 days of service, but the procedure for requesting exceptions when specific criteria are met (eligibility determinations, third-party denials, or department approvals) has been clarified with new documentation requirements.
Action Required
Immediately: Pennsylvania billing staff must update 180-day exception request procedures. Use new 180-day Exception Request Detail Page form for all late claims meeting criteria. Include original paper claims (no copies), proper supporting documentation (PA162 notices, EOBs, or department decision notices), and mail to updated address: Department of Human Services, 180-Day Exception Unit, P.O. Box 8042, Harrisburg, PA 17105-8042. Ensure resubmitted claims within 365 days include 13-digit ICN and RA number in remarks section.