PCPA has again met with the Office of Medical Assistance Programs (OMAP) and EDS representatives working on PROMISe. During this meeting several important items of interest were shared.
Use PES Version 3.5
The latest version (3.5) of the Provider Electronic Solutions (PES) software must be used. Older versions used to submit claims will have all of their claims rejected. The new version of PES is available by going to www.dpw.state.pa.us/omap/provinf/PESV2.asp.Common Errors
- Invalid Place of Service Codes
- Must use HIPAA values
- Reference the Place of Service Crosswalk at www.dpw.state.pa.us/omap/provinf/omapplaceofsvcxwalk.asp
- Provider Number Errors
- Must use 13-digit provider numbers
- The number used must include the service location code where the service was actually provided, not the “mail to” or “lock box” number.
Important Reminders from OMAP
- Use the Provider Handbooks, Billing Guides, Companion Guides, and HIPAA Implementation Guides to determine valid values.
- Provider numbers have changed for ALL providers, including billing, rendering, and referring providers.
- Use the Prior Authorization Number on notices even if they were generated from MAMIS. These MAMIS-generated numbers will continue to be used until the authorization is closed.
- Use production submitter IDs and not test submitter IDs when submitting electronically.
- Verify claims for accuracy and completeness.
- Providers having difficulty using their vendors to submit claims may consider alternatives until these problems are resolved. These alternatives include submitting bills online or using the PES software.
- Providers who wish to access ePEAP to make changes to their provider file may create an alternate ID whereby all provider numbers can be viewed simultaneously. Otherwise, providers will need to log in separately for each provider number they want to modify. Instructions for setting up an alternative are available in the Internet users manual at www.dpw.state.pa.us/omap/provinf/ProvInternetManual.pdf. In the manual version with revision date 03/03/04 this information is available on page 21.
Contact Information for PROMISe Questions
Please use these methods prior to contacting PCPA.
Provider Inquiry Lines
Practitioner Unit 800-537-8862
Pharmacy Unit 800-932-0938
Ancillary Unit 800-537-8861
Inpatient Unit 800-822-2901
Long Term Care 800-932-0939
OMHSAS Assistance Line
800-433-4459
Provider Assistance Line (For PES software and electronic billing questions only)
800-248-2152
OMAP’s PROMISe web site
www.dpw.state.pa.us/omap/promise/omappromise.asp
PROMISe email
promise@state.pa.us (Be sure to include the MAMIS provider number and a mailing address if requesting a new PROMISe provider number.)Members will need to include the following information, as appropriate, in order to ensure that their questions can be answered:
- Name of Agency
- Contact Person
- Phone Number
- Email address
- PROMISe Provider Number Being Used (including the service location)
- MAMIS Provider Number (if requesting a PROMISe provider number)
- Address to which information should be sent
- Method of Claim or EVS Submission (PES, Online, Software Vendor [include name])
- ICN for Claims Being Rejected or Not Going Through
- Error Codes or Error Messages Being Received
- Date of Claim or EVS Submission
- As many other details as possible
Send PROMISe Problems to PCPA
PCPA members who continue to have problems submitting claims may submit an email to PCPA (mail@paproviders.org) who will then forward this information to the appropriate person. The Association is working to address the most critical problems for agencies or the system as a whole, therefore PCPA is triaging all requests for assistance. Members can help PCPA evaluate the level of need by completing the attached form when submitting PROMISe questions or concerns.PCPA has learned that several members are concerned about significant cash-flow problems if claims continue to be rejected. PCPA members in this situation are encouraged to complete the attached form and indicate that the request is of an urgent nature. In these situations, please include information about the fiscal impact on the agency. If there appears to be a pattern among the rejected claims, for example if all claims for a specific service are being rejected, please include this information as well.