Eligibility Verification Information

Pennsylvania Medical Assistance (MA) PROMISe™ Update for Recipient Eligibility Verification 

OMAP and HPE are providing Provider Electronic Solution software free-of-charge for download from the OMAP Web site.

Web InteractiveA Web eligibility window is available to approved providers and other agencies. The Web address for this is http://promise.DHS.state.pa.us/ and click on PROMISe online. To send recipient information click the appropriate button on the Web page; the result returned is displayed on the Web page.
EVS Software

The MA HIPAA-Compliant PROMISe™-Ready software referred to as Provider Electronic Solutions Software - replaces OMAP’s past EVS Software. It is available free-of-charge by downloading from the OMAP PROMISe™ Web site at https://promise.DHS.state.pa.us/ePROM/_ProviderSoftware/softwareDownloadForm.asp . To order the software on CD-ROM, call 717-975-4100. 

MainframeProviders developing their own access method will need to consult both the PROMISe™ Companion Guide for the ANSI 270/271 transaction as well as the HIPAA specifications for the 270/271. The Companion Guides provide Pennsylvania specific information required in the transaction. The Companion Guides can be found here. Providers will also need to register and be certified by EDS, the Department of Human Services’s claims processing contractor. To register, please go to http://promise.DHS.state.pa.us/ePROM/_ProviderSoftware/softwareDownloadMain.asp and complete the certification/registration form.
Batch EVS

Batch EVS will need to be submitted utilizing the ANSI 270/271 transactions. Batch EVS capabilities have been built into the Provider Electronic Solutions software which provide for a simple data entry, submission, and receipt process. Providers submitting Batch EVS transactions will need to register in order to gain access to the Batch Bulletin Board System (BBS). For more information on registration please visit the OMAP Web site.

Providers will also have the option of building their own solution or purchasing commercial software; however, the application will need to pass the certification process prior to gaining access to the production system Batch BBS.

TelephoneMust use new 13-digit provider number. Providers utilizing the telephone access method will still dial 800-766-5387 to determine recipient eligibility.