RCPA - Rehabilitation and Community Providers Association


OMHSAS Eligibility Category
April 28, 2010

PCPA recently received member questions about a new eligibility category used by the Office of Mental Health and Substance Abuse Services (OMHSAS). There was confusion about coding for individual eligibility for Medical Assistance (MA) services versus county mental health programs. OMHSAS provided clarification through Remittance Advice Alert/PROMISe Banner Page, New OMHSAS EVS MHX Category, issued December 14, 2009. This alert notified providers of a new category/program status combination used in the Eligibility Verification System (EVS). OMHSAS is implementing a system to track mental health service encounter claims for “County Mental Health Funded Base Programs.” A staged schedule is planned, with implementation beginning in Berks, Bradford, Sullivan, Dauphin, Erie, Northampton, Wayne, and Westmoreland counties.

MHX identifies individuals eligible for services paid through county mental health programs, but who may not be eligible for MA services. If an individual is eligible for state services other than MA (e.g., food stamps) the individual will be authorized using a separate case number with a category/program status combination. MHX category eligibility is retroactive to July 1, 2008. Counties in the first phase of implementation began submitting encounter claims on December 14, 2009. If MHX is the only category for an individual, then the person is only eligible for county-based services. Providers cannot serve these individuals and receive payment from MA and through PROMISe. If a provider serves individuals in the MHX category, the provider must have a contract with the appropriate county. The complete Remittance Advice Alert is available at www.dpw.state.pa.us/PartnersProviders/MedicalAssistance/AlertsBanners/003681746.htm.


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