Keystone First — Complete guide to the customer service number and how to use it

This guide is written for members, caregivers and providers who need to contact Keystone First — how to find the correct customer service number, what to expect on the call, how to escalate problems, and practical steps that get results. Keystone First operates multiple lines (member services, provider services, behavioral health, dental, appeals and prior authorization), so the single most reliable source for the correct phone number for your situation is the back of your Keystone First member ID card and the plan’s official website: https://www.keystonefirstpa.com. Always verify the number on your card; numbers can vary by county, plan type (e.g., Medicaid Managed Care vs. Medicare Advantage vs. Community HealthChoices) and by whether the request is clinical, administrative or an appeal.

Many members find the centralized member services line is the quickest way to get routed correctly; for members who are deaf or hard of hearing, TTY/Relay 711 is supported. If you do not have your ID card available, log in to the secure member portal on the Keystone First website or reserve a one-time phone callback through the site. When in doubt, the plan’s website and your ID card are authoritative — call center numbers are sometimes updated annually or by county contract, so checking your materials prevents misdirected calls.

Where the phone numbers differ and why it matters

Keystone First runs separate phone channels for distinct functions: general Member Services, Behavioral Health, Dental, Provider Services (for billing, enrollment and credentialing), Pharmacy/Prescription Benefits, and Appeals & Grievances. For example, a pharmacy prior authorization will usually be handled by the pharmacy benefits team and will have faster turnaround if you call the pharmacy-specific number; similarly, billing disputes and provider credentialing are routed to Provider Services and can require different documentation than a member complaint.

Because different lines have different staffing hours and performance metrics, choosing the correct number up front saves time. Typical call-center best practices applied across managed-care plans include: Member Services handles eligibility, benefits and ID-card replacements; Pharmacy inquiries go to the pharmacy help desk; prior authorizations usually have a separate fax and phone. If you cannot get through to the right team, request a warm transfer to the correct department and an internal reference number for the call.

What to expect when you call — times, documentation and average handling

Standard operating hours for non-urgent Member Services are commonly Monday–Friday, roughly 8:00 a.m. to 6:00 p.m. local time; however, many plans offer 24/7 nurse advice lines and after-hours support for urgent clinical needs. Average live-answer times vary by volume and season (for Medicaid plans, open-enrollment and annual renewal windows increase volume dramatically). Reasonable planning assumes a 5–20 minute total call time during business hours; wait times longer than 30 minutes should prompt a request for a callback or escalation.

When you call, the representative will request identifying information to locate your record quickly: member name, date of birth, member ID number (from your card), address, and possibly the last four digits of your Social Security number. For provider calls, expect to provide NPI, Tax ID and the claim or authorization number. Having claim numbers, dates of service, provider names, and any written denial or explanation-of-benefits documents on hand speeds resolution and reduces call-backs.

• Information to have ready before you call: member ID number; full name and DOB; provider name and NPI (for provider issues); date(s) of service; claim or prior authorization number (if available); a clear short summary of the issue and the resolution you want (payment, authorization, appointment help, appeal).
• Documents to upload or fax if requested: copy of the provider’s order/notes, claims remittance or EOB, prior authorization denials, any clinical documentation (labs, consult notes). Fax and secure portal upload are faster than postal mail for supporting an appeal.

Appeals, grievances and escalations — timelines and practical steps

If your concern is denial of services, a disputed claim, or dissatisfaction with care access, Keystone First must provide internal appeal and grievance procedures. Under federal and state managed-care rules, standard appeals are typically resolved within 30 calendar days of receipt, and expedited (or “fast”) appeals for urgent medical needs are handled within 72 hours. These timelines are statutory for Medicaid managed-care organizations and apply to most actions that adversely affect coverage or services.

To preserve appeal rights: file in writing when possible, include a clear statement of the decision you are contesting, relevant dates-of-service, copies of supporting medical records, and the remedy you seek. Use certified mail or an uploaded file to get a timestamped receipt. If the internal appeal is denied, you will receive a written notice that explains your right to an external review by the state regulatory authority and how to request it (the notice must contain the external review contact details and deadlines). Keep copies of everything and note call reference numbers for all customer-service interactions.

Escalation ladder and sample language you can use on the phone

If the front-line representative cannot resolve the issue, request the following escalation steps: a supervisor review, a reference number for the escalation, and an expected timeframe for callback. If the supervisor response is unsatisfactory, ask for a written summary of the decision and the formal appeals packet. If the issue remains unresolved after the internal appeal, you have the right to an external independent review through Pennsylvania’s insurance or Medicaid external review process.

• Escalation steps (practical): 1) Call Member Services and get a call reference; 2) Ask for Supervisor/Manager review; 3) File a written appeal with supporting records and request expedited review if urgent; 4) If denied, request external review instructions and contact Pennsylvania’s Department of Human Services or the PA Insurance Department for managed-care appeals.
• Sample phone script: “Hello, my name is [Name], DOB [MM/DD/YYYY], member ID [#####]. I’m calling about a denial for [service] on [date]. My provider is [name, NPI]. I’d like to request a supervisor review and the internal appeals packet. Please give me the call reference number and a timeframe for a decision.”

Final practical notes: always verify the plan phone number on your membership ID or the official Keystone First website (https://www.keystonefirstpa.com), use TTY/711 if needed, and keep a concise chronology in a dedicated folder (dates, who you spoke with, reference numbers). That disciplined approach reduces turnaround time and increases the chance of a favorable and timely resolution.

Is Keystone first Pennsylvania Medicaid?

Keystone First is a Medical Assistance (Medicaid) managed care health plan that was founded by the Sisters of Mercy in 1982 to help people get care, stay well, and build healthy communities. Today, we remain committed to that mission.

What’s the best Medicaid insurance in PA?

An AI Overview is not available for this searchCan’t generate an AI overview right now. Try again later.AI Overview In Pennsylvania, several Medicaid health plans stand out for their quality and coverage. UPMC for You, Aetna Better Health, and UnitedHealthcare Community Plan are frequently cited as top options. Gateway Health Plan is another well-regarded choice. These plans offer comprehensive benefits and access to a wide network of doctors and healthcare facilities within the state.  Here’s a more detailed look at some of the leading plans:

• UPMC for You: . Opens in new tabThis plan is known for its strong network of doctors and facilities, providing members with access to quality healthcare services. 
• Aetna Better Health: . Opens in new tabAetna Better Health is a national company with a strong presence in Pennsylvania, offering a variety of Medicaid plans to meet diverse needs. 
• UnitedHealthcare Community Plan: . Opens in new tabUnitedHealthcare also offers a comprehensive Medicaid plan in Pennsylvania, with a focus on providing accessible and quality healthcare. 
• Gateway Health Plan: . Opens in new tabGateway is another popular choice, providing a range of Medicaid services and benefits. 

When choosing a Medicaid plan, it’s important to consider factors like your specific health needs, the doctors and hospitals you prefer, and the overall cost of the plan (including premiums and out-of-pocket expenses). You can compare plans and learn more about eligibility requirements at Medicaid.gov. 

AI responses may include mistakes. Learn moreBest Medicaid Health Plans – Freedom Care Best Medicaid Plans in Pennsylvania * Aetna Better Health. Aetna Better Health is one of the Medicaid health plans available for …FreedomCareBest Medicaid Health Plans PA – Freedom Care2022 UnitedHealthcare Dual Complete® – PA (HMO D-SNP) This health plan is a dual-eligible special needs plan. It’s designed for be…Freedom Care(function(){
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How do I contact my Keystone customer service number?

You can chat with us by clicking the icon at the bottom right of any Keystone webpage, call us at 1-800-464-2680, or email us at [email protected]. We’re live-staffed from 8:30 a.m.-5 p.m. ET Monday-Friday, and monitor 24/7.

Who is Keystone insurance?

Keystone Insurers Group offers a couple of personal and commercial insurance products, as well as financial services, employee benefits, and bonds. Keystone Insurers Group was founded in 1983. The company is headquartered in Northumberland, PA.

How do I contact customer service for Medicaid?

California

1. California State Contacts.
2. Eligibility.
3. Enrollment.
4. ☎ Call the Medi-Cal Helpline: 800-541-5555, or 916-636-1980.

What is the number for 1 800 521 6860?

If you did switch plans and want to return to Keystone First/AmeriHealth Caritas PA, please call the number on your insurance card (or 1-800-521-6860) to speak with a representative. You may also contact your designated Keystone First/AmeriHealth Caritas PA Care Manager directly for assistance.