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PROMISe is Coming… Get Ready!
February 7, 2004

PCPA has again met with representatives from the Office of Medical Assistance Programs (OMAP) and EDS, the contractor developing PROMISe. PROMISe (Provider Reimbursement and Operations Management Information System) will “go live” on March 1, however many deadlines to prepare for implementation are fast approaching. The following information was shared during this meeting.

Use of Local Codes
The use of local codes has been extended through June 30; likewise, all procedure codes that had been end-dated will be accepted until that time. A new Medical Assistance bulletin is expected within the next week announcing this. PROMISe will accept the current local codes until that time and will also be able to accept new HIPAA-compliant codes. The final procedure code crosswalk still has not been published. As soon as PCPA is aware of the final crosswalk, members will be notified.

PROMISe Provider ID
Several members have contacted PCPA regarding numerous new provider IDs they have received in the mail. These new provider numbers have identified sites that no longer exist, provider types that the agency believes they never had, etc. Additionally, some members have called to say that they have NOT received new provider numbers for some of their provider types and/or sites. OMAP is urging the following:

To close a service location:

  • Be sure that the service location is not being used.
  • A service location may appear in the Provider Crosswalk if it was active within the last two years. Be sure to check the status first (active/inactive).
  • To close or make changes to a service location, complete the form included with the Provider Crosswalk document.

To close a provider type:

  • If a provider type is inaccurate and needs to be closed, go to the OMAP web site (PROMISe section) and complete a Provider Enrollment form.

To ask OMAP a question related to PROMISe:

Those providers who have not yet received a new provider ID for one or more of their provider types or service locations, send an email to the PROMISe web site (promise@state.pa.us) or call the appropriate Provider Inquiry number. When emailing, be sure to include a valid mailing address to which the new Provider ID Cross Reference letter should be sent.

Paper Billing
The new paper claim forms will be accepted on February 9. When using the new forms, the new provider IDs MUST BE USED. The CMS-1500 replaces the MA 319 form and the UB-92 replaces the old MA 390C.

Electronic Billing
OMAP will accept claims in the old format if they are received by February 12 at noon. It is expected that a large number of bills will be submitted right before this deadline, possibly causing a backlog so that OMAP will not receive the claim in time. Be sure to submit claims as early as possible to avoid this backlog.

All claims that are in a pended status on February 13 will be rejected and will need to be re-submitted in the new PROMISe claim format. These claims will be returned with an Explanation of Benefits indicating that the bill was rejected because of its pended status.

Provider Inquiry Lines
OMAP has implemented an Interactive Voice Response System. A lot of answers to commonly asked questions are now available through this system, which is being updated continually.

  • 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

Provider Electronic Solutions Software
An updated version of the Provider Electronic Solutions Software is expected to be available on February 9. Older versions will not be accepted by PROMISe, however this new version cannot be used until PROMISe is implemented on March 1. If the software was originally downloaded, the new version can be downloaded from the PROMISe section of the OMAP web site. If the software was ordered through the provider assistance center, the new version will be mailed to the original shipping address automatically.

New Provider Enrollment
New providers may now complete the new Provider Enrollment Form. Additionally, providers requesting new provider types or new service locations should use this form.

HIPAA/PROMISe Certification
Providers must become PROMISe certified in order to bill this new system. Those agencies that have already become “HIPAA Certified” with OMAP are considered to be certified for PROMISe also. Providers who did not become HIPAA Certified must now become PROMISe certified. Any agency that is not PROMISe certified will not be able to bill electronically after March 1.

Clearinghouses
OMAP has received many requests from clearinghouses to obtain the new provider numbers of their customers. OMAP will not give these numbers to clearinghouses; therefore providers must give their new provider numbers directly to the clearinghouse.

Still Have Questions?

  • Go to the PROMISe eLearning site at http://promise.dpw.state.pa.us and take the online course.
  • Participate in the PCPA sponsored PROMISe conference call on February 19. Conference call information is available by contacting Rebecca May Cole. Be sure to submit questions in advance!

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