RCPA - Rehabilitation and Community Providers Association


PROMISe Conference Call Questions and Answers: Part 1
February 27, 2004

PCPA offered a PROMISe teleconference on February 19 which provided members with an opportunity to ask numerous questions of staff from the Office of Medical Assistance Programs (OMAP) and EDS. PCPA has begun to compile the questions and answers into a document that will be available to all members. In order to get the information out as quickly as possible, the decision has been made to publish a portion of the questions and answers periodically over the next few days. OMAP will be publishing an official answer to all of the questions on its web site and will also make a copy available to PCPA members. Contact Rebecca May Cole with any questions.

Questions and Answers: Part 1

How do you add a new Provider Service Location using PROMISe?
Go to the Office of Medical Assistance Programs (OMAP) web site and download a provider enrollment application. A new application must be competed to add a location to your record. If changes need to be made to an existing location – such as address – providers should use ePEAP (Electronic Provider Enrollment Automation Project).

What steps has OMAP taken to improve the turnaround time for the Provider Inquiry Lines to within one working day?
A number of staff were added to work on the OMAP provider inquiry lines effective Monday, February 17. Three additional staff were added to the OMHSAS hotline at 800-433-4459.

Does our referring physician need a service location at our physical site?
For outpatient behavioral health services and partial hospitalization, the rules have not changed. The doctor that is being listed (on the CMS 1500 block 17 insert name and degree; block 17a enter the provider ID) should be the attending or supervising physician. If the physician does not have a service location that correlates to the facility, the provider should use ePEAP or an enrollment form to add that location to the physician’s file. Initially providers will be able to bill in this situation as long as a valid service location is used. This is only an interim allowance until the physician’s file can be updated, which should be done as soon as possible.

How are paper claims affected?
Five blocks have been changed in the CMS-1500 from how they were used in the MAMIS system: blocks 5, 10d, 19, 32, and 33. Providers must use original forms only, no photocopied or computer-printed versions can be accepted.

Block 5: This is an optional field where the provider can enter the patient’s address.

Block 10d: A biller can enter the social security number of the primary insured if the primary insured is other than the MA recipient (optional). This block can also be used for the referral codes that are listed on the DPW web site.

Block 19: Do not enter the number of attachments (as was required in MAMIS). Providers must only use attachment type codes. The attachment type codes are the same as those for MAMIS, however a prefix of “AT” must be added. For example, if the attachment code was “09” under MAMIS (Medicare denial on file), the provider would now enter “AT09”.

Block 32: When services were provided in a hospital, enter the name of the hospital and the hospital’s 13 digit ID.

Block 33: If an individual assigns payment to a PROMISe enrolled group, the individual’s number is entered next to “PIN #” and the group’s number is entered next to “GRP #”. When payment is being assigned to a PROMISe enrolled group, enter the address to which you want the payment sent.

A follow-up question was asked regarding what should be entered in blocks 31 and 17a.
Block 17a: For family based or crisis intervention services, block 17a will be optional. Billing guides will be updated soon to reflect this information.

Block 31: Individual practitioners must provide their signature in block 31. For other providers such as outpatient psychiatric clinics or outpatient D&A clinics, the person who is authorized to sign this block would sign here.

With a low volume of FFS patients, would it be beneficial to set up so claims could be submitted electronically?
Yes. Providers with a low volume of fee for service patients can either use the Internet or the Provider Electronic Solutions (PES) software in this situation.

PES can be ordered through 717-975-4100 for a shipping and handling charge of $19.95 or can be downloaded for free at promise.dpw.state.pa.us.

Will providers be getting a new list of patient MA ID #'s?
Patient MA ID numbers will still be obtained from the Access card. No new list of patient ID numbers will be sent, as they have not changed.

What services will be available online?
Providers will be able to submit claims electronically, through the Internet, by using PES, or by using another software program that has been certified with OMAP.

Providers will be able to check claims status online – regardless of how they submitted the bill. In cases where a paper bill was submitted, sufficient time for OMAP to enter the claim into the system is necessary, after which the status of the claim will be available. Using the Internet method of submission, an immediate response is given as to whether the claim was accepted, rejected or suspended.

Remittance advice information will also be available online. This information will be available beginning with PROMISe and will be available retroactively for a total of 2 years. Only those claims processed through PROMISe will be available online, claims processed by MAMIS will not be available in this manner. This information will not be available on March 1, but will be available shortly thereafter.

Attachment control numbers (ACN) will be available online. The ACNs are used when submitting electronic claims that need paper backup information. The ACN is requested and is assigned to a specific document that is sent separately via US mail. This number will be used by OMAP to associate the correct paper document with the appropriate claim. These paper documents must be received by OMAP within 14 days or they will not be processed properly. ACNs will only be available via the Internet. Requests for ACNs will only be accepted online.

Providers will be able to use ePEAP to make basic changes to service locations or “mail to” addresses, etc. Incorrect provider types and the enrollment process for a new service location must be done by downloading the provider enrollment form and submitting it to OMAP.

Can funding be direct deposited?
Yes. OMAP uses an automated clearinghouse. The phone number to register with the clearinghouse is 800-248-2152. If a provider was set up for direct deposit in MAMIS they will also be set up in PROMISe. If they were not set up for direct deposit prior to December 1, the provider must call this number to enroll.

Please discuss protocols in changing provider data information.
EPEAP can be used to make basic changes such as changes in Medicare numbers or service locations. Providers will not be able to enroll a new service location through ePEAP. The ability to use ePEAP will now be available to all providers, whereas previously this was not available to everyone. If a provider was not signed up for ePEAP in MAMIS, they will not be able to register until March 1. A provider who was registered to access ePEAP in MAMIS will be able to do so in PROMISe.

We continue to have payment rejections due to "other insurance" even when that insurance is no longer valid for an individual yet it continues to show up on MA RAs. How can this be corrected?
If a MA recipient’s eligibility information is returned with a specific insurance coverage provided, even if that coverage no longer exists, the provider still must submit a bill to that insurance company and receive a rejection. They then would need to identify the appropriate attachment code when billing PROMISe. (For example, if the provider received a rejection from Medicare, the provider must indicate this with the attachment code “AT09” in the appropriate place. More information about attachment codes is available in an earlier question. In order for changes to be made, the MA recipient will need to talk to their case manager at the county assistance office and request that changes be made to their coverage reflecting that a specific insurance coverage is no longer available.

Whom can we contact if we have problems?
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
Provider Assistance Line (For PES software and electronic billing questions only)
OMAP’s PROMISe web site
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.)

What is the turnaround time for payments?
The turnaround time for payments has not changed. Approximately 31 – 45 days will be necessary to receive the remittance advice and a check. Providers will, however, be able to check claims status much sooner (based on the method of claim submission) via the Internet.

What happens to our billing if there is a system problem?
The Department of Public Welfare will work diligently to make sure that the problem is corrected. They will also do their best to not affect cash flow. If providers have submitted bills and don’t see a Remittance Advice statement within 45 days should resubmit it right away.

Please discuss protocols in changing provider data information.
Providers should change their information via ePEAP.

How do I access the PROMISe system?
For Internet site claim submission, ePEAP, or claims status, go to the PROMISe web site at promise.dpw.state.pa.us. This same address has an online training program available. Providers will need a User ID and Login number, which is obtained the first time the PROMISe Online is accessed. This registration process is real-time and is available now. Users will select their own User ID and Login number. The eLearning course is available now. EPEAP, claim status and attachment control numbers will be available on March 1. Remittance Advice status will be available soon after that.
When using the PROMISe system to submit claims, this can only be done interactively. Batch filing is not available on-line, but is available through the PES software and other vendors.

Providers should use the electronic verification system (EVS) to obtain eligibility information. All current methods will be continued. Providers are to use the new 13-digit ID as of midnight, February 19.

When will documentation become available, and how do I obtain this documentation?
Provider handbooks and billing guides are available on the DPW web site now. Instructions on how to use PROMISe – Provider Internet Users Manual – will be available on this web site on March 1. Changes are being made to both handbooks and billing guides on a daily basis, so providers are strongly encouraged to use these documents on the web site rather than printing them. To determine how updated a document is, see the date that appears under the name of the document. That date is the date the document was last updated.

Are managed care payers going to be required to follow the same EPSDT guidelines as the dept.?
Managed care payers are not required to follow the same EPSDT guidelines as the Department of Public Welfare. These payers have some leeway for making determinations on how they will handle EPSDT services.

Will weight of the patient be a requirement for EPSDT screens? If so, when will this be implemented?
Weight will not be required for EPSDT screens. OMAP staff have not heard of any discussions that this will be included in the future.

How should immunizations for EPSDT screens be reported on the 1500-forms?
Providers should use the procedure codes for vaccines that are currently on the fee schedule. They will be reported in the same way as was required for MAMIS.

What will need to be in block 10d and 24h of the CMS 1500?
Block 10d: A biller can enter the social security number of the primary insured if the primary insured is other than the MA recipient (optional). This block can also be used for the referral codes that are listed on the DPW web site.

Block 24h: This block is always used to report visit codes. There may be times when additional codes would be entered when the diagnosis does not indicate the presence of another condition (such as pregnancy – code 09, or patient refused or failed to pay the copay – code 11. Code 11 is used for informational purposes only; OMAP will continue to deduct the copay amount from the fee.)

I have several service location IDs that are under the incorrect provider type, do I need to have those numbers corrected? How do I correct them?
When ePEAP is available on Marcy 1, log on to this service and end date the service location. If the provider has been assigned an incorrect provider type, they must submit an enrollment application and the change will be made. OMAP has added significant numbers of staff to update this information in order to provide this information as quickly as possible.
The provider enrollment form can be downloaded from the OMAP web site (www.dpw.state.pa.us/omap).

Currently ePEAP will only accept the old 9-digit provider number and password. When ePEAP is fully functional, providers should use the new 13-digit number. OMAP will update their web site when this change has been made.

If I have a service location ID for my "pay to" address, i.e. 0006, do I use that for all of my services or do I need to set up a “pay to” location for each service address? If so how do I set them up?
The service location should reflect where the service was provided. Each service location can be given a “pay to” address by using ePEAP.

When will we get a list of new procedure codes?
Recently OMAP decided to use local codes through June 30, 2004. MA Bulletin 99-04-04 is now explaining this. MA Bulletin 99-04-02 was made obsolete by this new bulletin. New standard codes will not be used until after June 30.

Is there another provider type appropriate for Type 50 BHRS providers?
There is not a specific new provider type to replace Type 50. BHRS services will be linked through specialty codes based on the base license. These conversions are not yet complete, however the Department is doing all it can to complete them before March 1.

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