Pennsylvania has over 600 Medicare-certified HHAs and operates HealthChoices managed care across 5 geographic zones. With UPMC, AmeriHealth Caritas, and other MCOs managing coverage differently in Southeast, Southwest, Lehigh/Capital, Northeast, and Northwest zones, eligibility monitoring is a daily challenge. ClientCare monitors every patient's coverage and screens your staff against the OIG/LEIE automatically.
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600+
Medicare-certified Pennsylvania HHAs
5
HealthChoices zones
$34K
Average annual loss per agency
Pennsylvania splits Medicaid managed care into 5 zones, each with different MCO contracts. A patient transferring from Southeast to Southwest PA may change MCOs automatically — silently dropping coverage continuity.
UPMC’s dominant role in PA healthcare creates unique managed care dynamics. Patients enrolled in UPMC plans who seek services from non-UPMC agencies face coverage complications that can only be caught with real-time eligibility checks.
Pennsylvania’s Community HealthChoices program for dual-eligible and long-term care patients adds another layer of eligibility complexity. CHC managed care plans require separate monitoring from standard Medicaid.
Eligibility monitoring and compliance screening purpose-built for the Pennsylvania home health market — from Philadelphia to Pittsburgh.
ClientCare checks every Pennsylvania patient’s Medicaid and Medicare status on a rolling basis — across HealthChoices zones, UPMC, and AmeriHealth Caritas plans. Know before the next visit, not after the denial.
Every staff member is screened against the federal exclusion list every month. 100% of your Pennsylvania workforce, zero sampling, fully automated.
Get notified the moment a patient’s eligibility changes across any Pennsylvania Medicaid managed care plan. Plain-English alerts tell you which patient, which payer, and what to do next.
Export your roster from WellSky, Axxess, AxisCare, or any system used by Pennsylvania agencies. Upload the CSV and screening starts automatically — no special formatting required.
Pull patient and staff CSVs from WellSky, Axxess, AxisCare, or any EMR used by your Pennsylvania agency. No special formatting required.
Drag and drop your files. Our system maps columns automatically, starts eligibility checks across all Pennsylvania Medicaid managed care plans, and screens staff against the OIG/LEIE.
ClientCare monitors eligibility on a rolling basis across HealthChoices zones, UPMC, and AmeriHealth Caritas plans. You get alerts the moment coverage changes — not after a denial stacks up.
We also serve home health agencies in: