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PROMISe Update #04-01
March 23, 2004

Through working with staff of the Department of Public Welfare and other PCPA members, the Association is able to provide the following PROMISe related information.

Payment Cycle Delay
The first PROMISe payment cycle (cycle 39) was supposed to be mailed on March 17, however these checks (or direct deposit) will be delayed one day and be mailed on Thursday, March 18. The checks for cycle 40 are on schedule to be mailed on Wednesday, March 24.

Use the Internet Claims Submission Process as a Test
Try using the Internet claims submission process available through http://promise.dpw.state.pa.us. While many providers are submitting claims via the Provider Electronic Solutions, other vendor software, or by using the bulletin boards, it may be beneficial to try submitting one or two claims through the Internet claims submission process. When using the Internet claims submission process, each claim is being processed instantaneously, therefore if information is entered that is incorrect, a message will appear on the screen indicating that the information is wrong and why. By working through one or two claims this way, providers may be able to determine why claims are being rejected or pended and then translate that information over into the method of claim submission that is usually used.

Use of Modifiers in BHRS
There has been a lot of confusion about whether or not BHRS services require a modifier. It is our understanding that providers should NOT use modifiers for BHRS services.

Gross Adjustments May Be Available
The Department of Public Welfare (DPW) has engaged in a contingency planning process to be implemented in situations where providers are facing significant financial problems due to the inability to process claims through PROMISe. Agencies will need to be prepared to provide the following information if they request a “gross adjustment” in these situations:

  • The number of attempts made to bill PROMISe.
  • The method of claims submission (Internet submission, PES, Bulletin Board, other software vendor, paper claims).
  • The types of rejections being received.
  • Is the agency HIPAA certified or PROMISe certified?
  • The total amount being requested.

DPW is prepared to make one gross adjustment per month, per legal entity, therefore take this into consideration when making this request. The Department will be selective in deciding which agencies will receive a gross adjustment, and will do so only when a significant financial problem is demonstrated. Providers are free to contact DPW directly, however PCPA is able to facilitate this process for members who are interested in requesting this gross adjustment. Contact Rebecca May Cole at PCPA to be connected with the appropriate DPW staff.

PROMISe Question Form
As billing problems continue to occur, please take advantage of the form PCPA has developed so that the Association can be sure all of the necessary information is passed on to the Office of Mental Health and Substance Abuse Services (OMHSAS). By completing all of this information DPW is able to answer questions more quickly and respond in a more timely fashion.

Contact Rebecca May Cole for more information about any of the above issues.

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