Pennsylvania HealthChoices Behavioral Health Billing: Which Plan Pays Your Claim
HealthChoices behavioral health billing in Pennsylvania works differently from the rest of Medical Assistance (Pennsylvania’s Medicaid program). Your patient’s county, not your practice, decides which managed care company pays for therapy and psychiatry. Get that one fact wrong and the claim goes to the wrong payer.
What is HealthChoices behavioral health billing?
Behavioral HealthChoices is the Pennsylvania Medicaid program that covers mental health and substance use disorder services. The Department of Human Services (DHS) says each county contracts with a behavioral health managed care organization, called a BH-MCO, and members are assigned to a BH-MCO by the county where they live (DHS, Behavioral HealthChoices).
County mental health offices oversee the program. The state Office of Mental Health and Substance Abuse Services (OMHSAS) works with the counties on their contracts.
Which BH-MCO pays your claim?
Five BH-MCOs cover Pennsylvania. DHS assigns each by county (DHS BH-MCO list, page undated, checked 2026-10-09).
| BH-MCO | Counties (examples from the DHS list) |
|---|---|
| Community Behavioral Health | Philadelphia |
| Community Care Behavioral Health Organization | Allegheny, Berks, Chester, Delaware, York, and many more |
| Magellan Behavioral Health of Pennsylvania | Bedford, Bucks, Cambria, Lehigh, Montgomery, Northampton, Somerset |
| PerformCare | Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon, Perry |
| Carelon Health of PA | Armstrong, Beaver, Butler, Crawford, Fayette, Indiana, Lawrence, Mercer, Venango, Washington, Westmoreland |
Find the full county list on the DHS page. The county where the patient lives decides the BH-MCO, not the county where your office sits. If you want a quick contact reference, our Pennsylvania insurance companies contact guide lists payer numbers.
Matching the patient’s county to the right BH-MCO is the foundation of HealthChoices behavioral health billing.
How do I know where to send a Pennsylvania Medicaid therapy claim?
Bill the BH-MCO for the member’s county of residence, not the member’s physical health plan. Every HealthChoices member has a physical health plan, and behavioral health runs through the county’s BH-MCO. There is no separate BH-MCO card, so you confirm coverage in the state’s Electronic Verification System (EVS) (PerformCare, HealthChoices program overview, January 2024).
Use this checklist at intake:
- Ask for the member’s ACCESS card and county of residence.
- Check eligibility in EVS and note the BH-MCO.
- Confirm you are in that BH-MCO’s network.
- Run the check again before each new authorization period or claim batch. Our insurance verification service page explains the habit.
Medicaid rules that apply to your practice
This section covers Medical Assistance only. Commercial and Medicare rules are different.
Enrolling is not the same as joining a network. Providers enroll in Medical Assistance through the state’s PROMISe system. DHS says enrollment does not guarantee a place in any MCO network, and some networks may be closed (DHS, PROMISe provider enrollment). The PerformCare overview adds that providers must be fully credentialed by the BH-MCO before joining its network. Our credentialing page explains the general process, and our network status guide covers staying in network.
Pharmacy is separate. The PerformCare overview says pharmacy benefits, except methadone, are paid through the physical health plan or fee-for-service. Prescribers should not expect the BH-MCO to pay for medication.
Community Health Choices is a different program. It serves people who are nursing-facility clinically eligible or dually eligible for Medicare and Medicaid.
Each of these rules shapes your day-to-day HealthChoices behavioral health billing.
What psychiatrists and psychotherapists should check
Psychotherapists bill the usual time-based codes. Review psychotherapy codes 90832, 90834 and 90837 and 90791 and 90792 evaluations first.
Psychiatrists bill evaluation and management (E/M) visits, often with psychotherapy add-on codes 90833, 90836 or 90838. Ask the BH-MCO’s provider relations team how it wants those combinations billed. Do not assume one BH-MCO’s rule applies to another.
For Medicaid HCPCS codes used in home and community care, remember the same code can mean different things by state. See our Medicaid HCPCS state guide and the Medicaid billing terms glossary.
Keep these habits in mind whenever you handle HealthChoices behavioral health billing for a new patient.
What happens when a county changes its BH-MCO?
Providers must follow the new company’s rules. Somerset and Bedford counties are the recent example. Community Care Behavioral Health Organization stopped serving as their BH-MCO and Magellan Behavioral Health of Pennsylvania took over on November 1, 2025 (Community Care provider notice). The notice points providers to Magellan’s site. Magellan lists its counties and provider services numbers at magellanofpa.com.
When a claim denies after a change like this, work the denial fast. Our denied claims follow-up and appeals page shows a sensible order of steps.
Review this list each time you change a process for HealthChoices behavioral health billing.
Frequently asked questions
Does Pennsylvania Medicaid use one plan for therapy and medical care?
No. Each HealthChoices member has a physical health plan, and behavioral health is handled separately by the BH-MCO for the member’s county.
Can I join a BH-MCO network just by enrolling in Medical Assistance?
No. DHS says enrollment does not guarantee a spot in any MCO’s network. Contact the BH-MCO directly and complete its credentialing.
Who handles behavioral health claims in Bedford and Somerset counties now?
Magellan Behavioral Health of Pennsylvania, effective November 1, 2025, according to the Community Care notice and the DHS BH-MCO list.
Does the BH-MCO pay for my patient’s prescriptions?
No. Per the PerformCare overview, pharmacy benefits other than methadone are paid through the physical health plan or fee-for-service.
Where MCM South Medical Billing Service Works
MCM South Medical Billing Service, LLC works exclusively with mental and behavioral health practices, including psychotherapists and psychiatrists, and bills out-of-network claims. We offer our services to practices in Pennsylvania, and we also work with practices in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. If you want to talk through your own billing, you can request a free consultation.
If you practice in Pennsylvania and want a second set of eyes on your billing, you can request a free consultation. More practice tips live in our resources hub and billing glossary section on network management.
