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Microsoft Word - MAB- Class I - Clarification of Payment Policy for Abortio...

Pennsylvania Medicaid (DHS)·PA · OB-GYN, Emergency Medicine, General Surgery·Reimbursement
Effective date
Nov 17, 2006
We identified it
Jun 20, 2026
Days to comply

Summary

Pennsylvania Medicaid has clarified certification requirements for abortion services reimbursement, revising forms MA-3 and MA-368 and consolidating MA-369 into MA-368. Providers must use the updated forms immediately for all abortion service claims to ensure proper payment.

Action Required

Action needed
Immediately: Download and begin using revised Physician Certification for an Abortion Form (MA-3) and consolidated Recipient Statement Form (MA-368) from the PA DHS website. Stop using obsolete form MA-369. Billing team must submit completed forms with all abortion service claims. Providers must complete appropriate sections based on life threat or rape/incest circumstances.