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Administrative Services
- ASC-SPU - Medicare HMO Billing Instructions - UB-04
- Billing for Tobacco Cessation Services
- Developmental Programs Provider Billing and Payment
- Inpatient - Medicare HMO Billing Instructions - UB-04
- Outpatient Hospital - Medicare HMO Billing Instructions - UB-04
- Professional - Medicare HMO Billing Instructions - CMS-1500
- Architecture Review Board
- Access Domain
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- Business Domain
- Data Domain
- Integration and Middleware Domain
- Knowledge Management Domain
- Network Domain
- Operations and Support Domain
- Platform Domain
- Privacy Domain
- Procedures Domain
- Security Domain
- Appendix I
- Appendix II
- Applicant Orientation Registration
- Consolidated and P/FDS Proposed Waiver Renewals Effective July 1, 2017 Submitted to CMS
- Developmental Programs Provider Licensing
- ODP Rates
- Provider and SCO Monitoring
- Provider Qualifications
- Amendments to the Consolidated, Person/Family Directed Support and Community Living Waivers Effective July 1, 2018
- Child Care Regulations
- Child Care Resources for the Business Community
- Early Learning Provider Requirements
- Keystone Stars Child Care Quality Initiative
- New for the Child Care Licensing Program
- Resources for Early Learning Providers
- ACCESS Cards, EVS, Eligibility Questions and Answers
- Behavioral Health Rehabilitation Services (BHRS) Frequently Asked Questions
- Billing and Claims Status Frequently Asked Questions
- Checks, Payments and Remittance Advice Frequently Asked Questions
- ClaimCheck Frequently Asked Questions
- Enrollment, Provider File Questions
- Forms, Invoices, Handbooks Frequently Asked Questions
- Medical Assistance 1099 Information
- National Provider Identifier (NPI) Frequently Asked Questions
- Nursing Facility Frequently Asked Questions
- Nursing Facility Medicare Part D Questions
- Prior Authorization Frequently Asked Questions
- PROMISe Frequently Asked Questions
- Bulletins, News and Announcements
- Enrollment Information
- Health Care Compliance Plans for Medical Assistance Providers
- Limited English Proficiency Interpreter Services for Medical Appointments
- MA Fraud and Abuse/Health Care Compliance Web Sites
- Managed Care Information
- Medical Assistance Health Information Technology Initiative
- Medical Assistance Programs Dictionary
- Special Pharmaceutical Benefits Program
Hearings and Appeals Process
Hospital Assessment Initiative
- Application for a Human Services License
- Child Residential and Day Treatment Center Forms
- Personal Care Home Forms
- Personal Care Home Licensing Regulations
- Regulatory Compliance Guide (RCG)
- Sale or Change of Legal Entity of Personal Care Homes
- Webinars
- General – Forms
- General – Miscellaneous Information
- General – Policy, Regulations and Interpretation Information
- General – Training Information
- Personal Care Homes – Miscellaneous Information
- Personal Care Homes – Policy, Regulations and Interpretation Information
- Personal Care Homes – Training Information
- Assisted Living Residences – Miscellaneous Information
- Assisted Living Residences – Policy, Regulations and Interpretation
- Assisted Living Residences – Training Information
- Child Residential and Day Treatment Center – Forms
- Child Residential and Day Treatment Center – Miscellaneous Information
- Child Residential and Day Treatment Center – Policy, Regulations and Interpretation Information
- Mental Health – Forms
- Mental Health – Miscellaneous Information
- Mental Health – Policy, Regulations and Interpretation Information
- Intellectual Disabilities – Forms
- Intellectual Disabilities – Miscellaneous Information
- Intellectual Disabilities – Policy, Regulations and Interpretation Information
- Detecting Medication Side Effects
- Health Care Quality Units
- Prioritization of Urgency of Need for Services (PUNS)
- Resources for Developmental Programs Providers, Administrative Entities (AEs), and Supports Coordination Organizations (SCOs)
- Supports Coordination Organization Qualifications
- 2005 COLA and Medicare Premiums
- Advance Public Notices for New Nursing Facility Rate Setting
- Average CMI's in Pennsylvania
- Average RUG III v. 5.12 44-Group CMI's in Pennsylvania
- Budget Adjustment Factor
- Civil Money Penalty Fund
- County CMI's in Pennsylvania
- County Nursing Facility MDOI Payments
- Disproportionate Share Incentive Payments
- Enterprise Incident Management
- Healthcare-Associated Infection (HAI) Payments
- Interpretive Guidelines
- MA 11 Cost Reports
- Minimum Data Set (MDS)–CMS MDS 3.0 Information
- Nonpublic Nursing Facility MDOI Payments
- Nursing Facility Processing Rate Adjustments and Group List
- Pennsylvania PASRR Process
- PA MSA Designations
- Participation Review Bed Requests
- Pay for Performance (P4P) Incentive Payments
- Peer Groups and Peer Group Medians
- Pennsylvania Nursing Facility Assessment
- Rate Setting Tables
- Rates
- Safety Net Payments
- Supplemental Ventilator Care Payments
- Health Insurance Premium Payment (HIPP) Program
- HealthChoices Expansion Training Guides
- Healthy Beginnings Plus
- Remittance Advice (RA) Mailing Dates/Electronic Remittance Advice (ERA) Delivery Dates
- What's New
- Act 21
- Alternatives to Coercive Techniques
- CCBHC
- County Mental Health System
- HealthChoices Behavioral Health Program Information
- Telephonic Psychiatric Consultation Service Program (TiPS)
- Credentialing Standards
- Diagnostic Criteria and Assessment
- Medical Assistance and Third Party Liability Related Information
- Coverage of Mosquito Repellents
- Covered Drugs
- Fee-For-Service Billing Information for Naloxone
- Helpful Guidelines for MA Coverage of Over-the-Counter Drugs
- Pharmacy Prior Authorization General Requirements
- Pharmacy Prior Authorization Guidelines
- Pharmacy Services Fax Forms
- Preferred Drug List Information
- Quantity Limits List
- State MAC List
- The Specialty Pharmacy Drug Program
PROMISe
- Certification
- Enrollment Information
- Error Status Codes and Descriptions
- Have a Problem with PROMISe?
- Place of Service Crosswalk
- Information about PA’s New Third Party Liability Law, Act 2008-44
- Information for Attorneys about Tristani v. Richman
- Information for Insurers about Tristani v. Richman
- Field Office Rate Setting
- Medication Administration Training Program
- Orientation Training for Child Care Providers
- Out-of-Home Placement Services Training Videos
- Personal Care Home Online Training
- PROMISe Provider Education and Training
- Search for Personal Care Home (PCH) Training
