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HealthChoices Systems Management

OMHSAS Division of Systems Management

The Division of Systems Management objective is to ensure eligible individuals can access behavioral health services covered by Medicaid and County Base-Funded Mental Health. This objective includes the management of various interacting state systems operations that ensures an individual can access services, management of the claim and/or encounter data, and conducting business intelligence activities with the behavioral health data received.

Information contained on this page is intended for the use of OMHSAS Behavioral Health business partners operating within HealthChoices and the County Mental Health Base Programs.

Contact Us

Listing below of all the relevant OMHSAS Division of Systems Management Resource Accounts

​OMHSAS Systems Division Resource Account
 ​Description of inquiries that this resource account is designed to respond.
RA-PWOMHSAS837ISSUES@pa.gov
​Questions related to Behavioral Health 837 institutional and professional encounters and all files outlined in Appendices M and O of the PS&R.
​RA-PWOMHSAS834ISSUES@pa.gov
​Questions related to Behavioral Health 834 transactions.
​RA-PWELIGDISCREPANCY@pa.gov
​Eligibility of individuals for Behavioral Health services
​RA-PWELIGREFERENCE@pa.gov
​Questions related to the Behavioral Health Services Reporting Classification Chart (BHSRCC). BHSRCC document is sent from the account. 
​RA-PWSERVICES@pa.gov
​Provider enrollment
​RA-PWICWC@pa.gov
​Integrated Community Wellness Centers
​RA-PW-BHMCOSecurity@pa.gov
​Access to state systems by business partners
​RA-PWOMHSASCCRIData@pa.gov
​Questions related to Consolidated Community Reporting Initiative (CCRI) within County Base-Funded Mental Health  

Systems Notices

Document Number
 ​Title
 ​Date Updated
OMHSAS 2020-001​
​MMIS Communication
​Feb. 10, 2020
​OMHSAS 2020-002
Denial Log Instructions​​March 11, 2020
​OMHSAS 2020-003
​Telehealth POS
​March 23, 2020
​OMHSAS 2020-004
​COVID-19 CARC
​April 3, 2020
​OMHSAS 2020-005
​COVID-19 CR Modifier DR Condition
​Aug. 21, 2023
​OMHSAS 2020-006
​Service History and Pharmacy File
​April 27, 2020
​OMHSAS 2020-007
​Cash Delinking
​April 30, 2020
​OMHSAS 2020-008
​Reapplication File
​Aug. 14, 2020
​OMHSAS 2020-009
​New Place of Service Codes
​Oct. 30, 2020
​OMHSAS 2020-010
​Encounter Data Adjudication Date BES
​Nov. 20, 2020
​OMHSAS 2020-011
​​Encounter Data Adjudication Date BES Update
​Dec. 4, 2020
​OMHSAS 2020-012
​Timely Encounters 
​Dec. 4, 2020
​OMHSAS 2020-013
​Behavioral Health Extensions During Cares Act
​Dec. 9, 2020
​OMHSAS 2021-001
​Provider Files
​March 22, 2021
​OMHSAS 2021-002
 ​Provider Files Update
 ​April 8, 2021
​OMHSAS 2021-003
​Reserved
​Reserved
​​OMHSAS 2021-004
​BH Extensions Override Manual Processes Discontinued
​April 29, 2021
​​OMHSAS 2021-005
​Service History File Field Additions June 2021
​June 16, 2021
​​OMHSAS 2021-006
​Encounter Data Attestation Forms
​Aug. 6, 2021
​​OMHSAS 2021-007
​Reserved
​Reserved
​​OMHSAS 2021-008
​Reserved
​Reserved
​​OMHSAS 2021-009
​NTE Segment — Modifier 95
​Nov. 4, 2021
​OMHSAS 2022-001
​Naloxone Take Home Supply — FQHCs/RHCs
​April 4, 2022
​OMHSAS 2022-002
​PH HealthChoices MCO Plan Changes
​Sept. 1, 2022
​OMHSAS 2022-003
​NTE Segment Changes
​July 1, 2022
​OMHSAS 2023-001
​CAO Notification Form
​Feb. 21, 2023
​OMHSAS 2023-002
​End of PHE System Edits
​May 12, 2023
​OMHSAS 2023 - 003
​Voiding and Adjusting Encounters​July 07, 2023
​OMHSAS 2023 – 004
​Resuming Timely Encounter Submissions
​July 26, 2023
​OMHSAS 2023 - 005
​Discontinuance of CR Modifier and DR Condition Code​Aug. 22, 2023
​OMHSAS 2023 - 006
​Error Status Code 519
​Sept. 14, 2023
​OMHSAS 2023 - 007
​OMHSAS_2023_007 Race Code Update -Z Code​Dec. 13, 2023


Encounter Documents

Program(s) Document Description Date Updated

















CCRI and HealthChoices
​ ​ ​ ​ ​ ​
​ ​		 U277 Companion Guide
This Companion Guide contains information for interpreting unsolicited 277 transactions which
are sent to notify managed care organizations (MCOs) about the status of their encounter data		June 2011
An X12 999 Functional Acknowledgment This report is generated for HIPAA transactions. A variety of errors can result in the transmittal of a 999 Functional Acknowledgment April 2022
BES Report Layout Requirements Business Exchange Services (BES) Report layout requirements February 2018
ESC Supplemental Extract Layout
This output file is an extract of encounters which processed in PROMISe™ for the previous day where the Paid or Denied Encounter set at least one PROMISe™ Error Status Code (ESC). December 2018
File Layout for Diagnosis Code File
The document outlines for Diagnosis Code File layout. December 2016
File Layout for PRV435
This MA provider file will be supplied to each plan by DHS once a week.  This file contains a listing of MA providers/service locations and special indicatorsMay 2021
List of Special Indicators List of Special Indicator CodesJanuary 2018
File Layout for PRV720
Provider Revalidation File (PRV720) File LayoutSeptember 2021
BH Edit Crosswalks
PROMISe Edits for HealthChoices & CCRI/EPOMS Behavioral Health EncountersOctober 2023
834 Companion Guide
This Companion Guide contains detailed instructions for interpreting Benefit Enrollment and Maintenance (834) transaction records that can be received from PROMISe in the 834 format. November 2023
SeGov Browser Instructions This document represents a guide to the functionality available to the SeGOV Https Browser UsersMarch 2011
Program(s) Document Description Date Updated















CCRI
​ ​ ​ ​ ​ ​ ​		 CCRI Anonymous Consumers Guidance for use of the Anonymous Consumer MHX Recipient Identification NumberUpdated:
July 2022
CCRI ASC Attestation Statement
CCRI ASC Attestation StatementMarch 2016
CCRI Edit Guide
CCRI Encounters Edit – Common Edits Information 718, 719, and 742March 2022
CCRI Reporting Tool
CCRI Reporting Tool UPDATED January 2024
CCRI Production Procedures
This guide is used to ensure the quality of data received will meet state and federal reporting requirements of client-level-data (CLD)March 2022
CCRI PROMISe™ Comprehensive Onboarding
A compendium of information related to the exchange of files between PROMISe™March 2022
CCRI PRV416 File Layout
Active and Closed Provider Service Locations with a PROMISe™ EPOMS Provider Eligibility Program on file June 2019
CCRI NTE Technical Assistance
CCRI NTE Technical Assistance October 2021
​CCRI Encounters Webinar
​CCRI Encounters Webinar PowerPoint 
​April 2022 
​CCRI Encounters Webinar Recording
​CCRI Encounters Webinar Recording
​April 2022 
​CCRI Encounters Webinar Q&A
​CCRI Encounters Webinar Q&A
​April 2022 
​SPS Services Reporting Procedures
​This document outlines reporting procedures for services rendered under a Specialied Payment Structure
​September 2023
​SPS Services Template
File layout specificaitons
​September 2023

CCRI-Specific System Notices

NumberTitle 
Date Updated
CCRI 2021–001
PRV720 PRV435 CommunicationApril 2021
CCRI 2021–002
NTE — Modifier 95Sept. 20, 2021
CCRI 2022–001 ReservedReserved
CCRI 2022–002
Adding EPOMS PEP to an already existing service locationMarch 16, 2022
CCRI 2022–003Provider Electronic Solutions Software (PES)March 31, 2022
​CCRI 2023-001
 ​End of PHE System Edits
 ​May 8, 2023
​CCRI 2023–002
 ​Voiding and Resubmitting Encounters
 ​August 23, 2023
​CCRI 2023–003
 ​Discontinuance of CR Modifier DR Condition Codes
 ​December 13, 2023

HealthChoices Reports

Report Title
 ​Description
 ​Date Published
​BH-MCO EDV Studies
​OMHSAS conducted an Encounter Data Valdiation Study with each primary contractor’s respective BH-MCO
​2023
​BH-MCO Onsite Reports
​OMHSAS conducts onsite reviews of the claim and encounter data submissions with each primary contractor’s respective BH-MCO
​ 2023
BH-MCO Onsite Reports
​OMHSAS conducts onsite reviews of the claim and encounter data submissions with each primary contractor’s respective BH-MCO
2019
​COVID-19 Powerpoint Presentation
Powerpoint presentation of the various system changes in response to the COVID-19 public health emergency​April 2020
​COVID-19 Presentation
Meeting Minutes
​Questions and answers from the presentation in April 2020
April 2020
​COVID-19 Presentation Attachments
​Attachments provided as part of the presentation in April 2020
​April 2020

HealthChoices Provider Enrollment Documents

The table below contains links to applicable provider enrollment forms for Capitation Providers.

​PROMISe™ Provider Type (Code and Description)
 ​Enrollment Documents
​
​07 - Capitation
​Capitation Enrollment Application HC BH
​Ownership and Control Document
​Guide: Requirements for Provider Type 07 - Capitation