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The Department of Human Services (DHS) is pleased to announce new provider enrollment portal enhancements designed to improve a provider’s enrollment experience. Providers will enter the enrollment portal from PROMISe™ using their existing registered login criteria. Upon successful login, providers will have access to these new enhancements:

  1. Applications for adding additional service locations, revalidations, and reactivations will prepopulate parts of your application;
  2. After logging into the portal, existing providers will be able to submit change requests to update their provider file without the need to complete a full application; and
  3. Proof of provider enrollment status with PA Medicaid is available to view and print.

See the PROMISe Quick Tips update for more information. If you do not have an existing login, please select “Register Now” in the Provider Login box and complete the process options. Additional enhancements are planned and will be communicated through future banner alerts and quick tips.

If you have further questions, please contact RCPA Policy Director Jim Sharp.

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Message from the Office of Mental Health and Substance Abuse Services (OMHSAS) Deputy Kristen Houser:

Providers of IBHS, mobile crisis services, family-based mental health services, and psychiatric rehabilitation services received an attestation form for HCBS Workforce Gap payments on or after January 19, 2022. Following release of the attestation forms, OMHSAS received concerns regarding the anticipated payment amounts and allowable uses of the funds. To address these concerns, OMHSAS committed to reviewing the data used in the methodology to calculate payments and released an FAQ on February 9, 2022.

On the original data run, the absence of available CY 2021 data was of particular concern for providers of IBHS, given that 2020 was a year of transition from BHRS to IBHS. When OMHSAS first pulled data to calculate payments to each of these provider types and locations, CY 2021 data was not available. We have re-run the payment calculations using CY 2021 data. Where CY 2019 data showed a more favorable outcome for a provider, the CY 2019 was used. The CY 2019 data was supplemented with 2021 data for FBMH, Mobile Crisis, and PRS provider locations that were not present in the CY 2019 data and that had more favorable data in CY 2021.

Please note that any previously submitted attestation forms will be considered null and void, and OMHSAS will be sending new forms with the new amounts reflecting the most complete claims data in the next few weeks. We will send notification through our email list when they are sent.

If you have not checked your contact information and both email and physical addresses in PROMISe, please do so immediately to help ensure the quickest method of notification.

If you have questions about provider qualifications or other topics related to these payments, please refer to our FAQs.

Thank you for your patience and understanding. We know these payments for workforce recruitment and retention are critical, and it is important to us that they be as accurate as possible.

ODP Announcement 22-025 serves to provide the hourly wage and benefits ranges for specific Participant Directed Services (PDS) for participants utilizing the Vendor Fiscal/Employer Agent (VF/EA) FMS model, effective March 1, 2022. The Office of Developmental Programs (ODP) updated the data used in establishing rates, which impacted the hourly wage and benefits ranges. The high end of the hourly wage and benefits ranges either increased or remained the same. There were no decreases to the high end of the hourly wage and benefits ranges. These wage and benefit ranges will be used to pay SSPs and to support claims processing in the Provider Reimbursement and Operations Management Information System in electronic format (PROMISe™) by the VF/EA FMS organization. This communication will only be updated when changes occur to the information contained within.

ODP Announcement 21-093 is a reminder to all providers and vendors that provider revalidation occurs every 5 years from the initial enrollment date or most recent revalidation date of every service location. The Office of Developmental Programs (ODP) is seeing an increase in claim denials because providers fail to revalidate their service location(s) on time.

NOTE: If an MA or base provider does not complete revalidation by their revalidation date, they will not receive payment for service locations that are end dated and closed in PROMISe™. Claims will be denied and show as denied on their remittance advices. Reactivation of closed sites will be required prior to billing/payment resumption.

In an effort to assist Infant/Toddler Programs and their contracted EI service providers to clear suspended claims from the PROMISe™ system, the Office of Child Development and Early Learning (OCDEL) has released guidance on the procedures for Early Intervention claim filing. Correct billing practices require adherence to correct filing procedures and time limits. All relevant information and instructions can be found in the PA PROMISe™ Provider Handbook for the 837 Professional/CMS-1500 Claim Form.

Time Limits for Claim Submission

DPW must receive claim forms for submissions, resubmissions, and adjustment of claim forms within specified time frames; otherwise, the claim will reject on timely filing related edits and will not be processed for payment.

Service providers (including service coordination entities) are required to submit original claims within 180 calendar days of the initial date of service. Claims which are received within 180-days of the date of service and subsequently denied may be resubmitted up to 365 calendar days from the original date of service.

Suspended Claims/180-Day Exception Request Process

ALL claims that are past the 180- or 365-billing day cycle AND directly associated to a reported PELICAN-EI systems issue are to be billed electronically through the PROMISe system. The claims filed will result in a “suspended” status. These suspended claims will be manually reviewed and approved by a Bureau of Early Intervention services staff member.

Approval of these suspended claims will require additional information submitted by the provider to the BEIS office via email. The email contents must include the following:

  • Provider name
  • MCI for the child
  • PELICAN-EI systems issue description and Help Desk Call Number

If the claim was suspended because it was past the filing limit and unrelated to a PELICAN-EI systems issue, you will need to provide an explanation for the delayed billing. Providing an explanation for the delayed billing will not automatically result in the claim being approved for payment. Each claim will be reviewed individually and considered for approval.

It is the responsibility of the billing entity to follow the requirements for timely billing as outlined in the PROMISe™ manual. Claims which have a suspended status will be denied unless the above procedures have been followed.

If you have any questions, please contact RCPA Children’s Policy Director Jim Sharp.

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Effective January 1, 2018, for HealthChoices Managed Care Clients, any MD, CRNP, or PA who prescribes any medication or makes a referral or order for a service, must be directly enrolled in the Medical Assistance Program and have their own MA ID number. Some D&A prescribers bill under the facility number, so many MDs, CRNPS, and PAs working at D&A Providers DO NOT have their own MA ID and will need to obtain one. Here is a link to the DHS website for PROMISeTM applications.