RCPA - Rehabilitation and Community Providers Association
 
 

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PROMISe Update #04-04
April 9, 2004

Provider Enrollment
Several providers have expressed concern because they submitted their enrollment applications (some as far back as December) and have not had any response. The Office of Medical Assistance Programs (OMAP) is experiencing a very high volume of enrollment applications at this time and is behind in their processing of these applications. The good news is that for some services their enrollment application can be sent through PCPA to the Office of Mental Healthand Substance Abuse Services (OMHSAS) who will process them. These services are Intensive Case Management (ICM), Resource Coordination (RC), Family Based Mental Health Services (FBMHS), Crisis, or any supplemental service in HealthChoices. The bad news is that Outpatient and Partial Hospitalization services must still be enrolled through OMAP.

To enroll ICM, RC, FBMHS, Crisis, and HealthChoices supplemental services, complete the appropriate form from the OMAP web site and fax it to 717-657-3552, attn: Rebecca May Cole. PCPA will only accept enrollment applications from its members at this time.

Suspended Claims
Some PCPA members have contacted PCPA to report that claims they have submitted are in a “suspended” status for a long period of time. If after a few weeks the claims continue to be in a suspended status, either resubmit the claim or complete a PROMISe Question Submission Form including the provider ID, ICN, and the date(s) the claim(s) were submitted for each claim that remains suspended. PCPA will then forward this information to OMHSAS for assistance. There may be a longer period of time for claims to be suspended while issues continue to be addressed. The PROMISe Question Submission Form is available by emailing rebecca@paproviders.org.

Use ePEAP to Add Service Locations
Practitioners that have a MA ID number must also have a service location that corresponds to the agency for whom services are provided. While the agency is not able to add service locations to the practitioners’ IDs, the practitioner can do so through the ePEAP (electronic Provider Enrollment Automation Program) system. The practitioner would need to log on to the PROMISe web site and click on the link for ePEAP. They can then add service locations as necessary. If this does not work, then a paper enrollment form must be completed.

Gross Adjustment Process Update
PCPA has learned new information about the timeframe for obtaining a Gross Adjustment from the Department of Public Welfare (DPW).

  • Submissions must be received by DPW by each Thursday at 2:00 p.m.
  • DPW will research the information the following week.
  • A check will be cut approximately 15 days later.

Members should use this timeframe to determine when (and if) they will need to request this adjustment. Contact Rebecca May Cole for more information.

Remaining Issues
PCPA is aware of the issues around using a practitioner’s MA ID number versus their license number. At this time it appears that PROMISe will only accept the MA ID number. OMHSAS is looking into this issue and PCPA will report any changes to members immediately upon receipt of the information.

Confusion continues around the ability of BHRS providers who are now type 08 to use place of service code 11 (office). At this time, we are told that place of service 99 (community) and 12 (home) are valid codes for these providers. PCPA will update members when more information about this issue is available.

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