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DHS COVID-19 PROVIDER RESOURCES // OMAP

CHIP Policy Clarification 2020-07: Provider enrollment and revalidation changes during the COVID-19 public health emergency

Issued: April 13, 2020

Audience

CHIP Managed Care Organizations (MCOs)

Purpose

To provide information to MCOs regarding Department actions around provider enrollment and revalidation changes during the COVID-19 public health emergency. 

Background

On March 6, 2020, Governor Tom Wolf issued an emergency disaster declaration in response to the presence of the COVID-19 virus in Pennsylvania. The COVID-19 outbreak was declared a national emergency under the Stafford Act on March 13, 2020, and a nationwide public health emergency on January 31, 2020 (retroactive to January 27, 2020). Consistent with Section 1 of the President’s March 13, 2020 national emergency declaration, the Department of Human Services requested flexibilities under Section 1135 of the Social Security Act on March 24, 2020. 

CMS approved, in part, the Department’s Section 1135 request for provider enrollment and revalidation flexibilities on March 27, 2020. The partial approval is available here. Providers of services within CHIP are required to utilize the same enrollment processes as outlined by Medical Assistance. The Department will apply these flexibilities as follows.

Discussion

For Providers Not Currently Enrolled in the Pennsylvania Medicaid Program, the Department:

    • Will provisionally, temporarily enroll providers without paying an application fee, which was described in Medical Assistance Bulletin 01-16-14.
    • Will provisionally, temporarily enroll providers assigned to the high categorical risk level temporarily without requiring finger-print based criminal background checks and a site visit. For more information regarding the high categorical risk level screenings please see Medical Assistance Bulletin 99-16-03.
    • Will provisionally, temporarily enroll providers assigned to the moderate categorical risk level temporarily without a site visit. For more information regarding site visits please see Medical Assistance Bulletin 99-16-13.  

For Providers Currently Enrolled in the Pennsylvania Medicaid Program, the Department:

    • Will not close provider service locations in PROMISe due to revalidation. All providers having a revalidation date during the period of the emergency disaster declaration will remain active in PROMISe. However, please note that if the provider has not revalidated OR submitted a revalidation application, the provider’s service locations will close in PROMISe the last day of the month the emergency disaster declaration ends. For more information regarding provider revalidation, please see Medical Assistance Bulletin 99-14-06.
    • Is suspending the requirement that the ordering, referring, attending, or prescribing provider must be enrolled in PROMISe for the claim to be paid. For more information about this requirement, please see Medical Assistance Bulletin 99-16-07.
    • Is suspending the denial of claims due to the rendering provider’s service location not being enrolled in PROMISe described in Medical Assistance Bulletin 99-18-11.

This guidance will remain in effect while a valid disaster declaration authorized by the Governor related to the COVID-19 virus remains in effect. OMAP may re-issue these guidelines as appropriate. 

Providers should continue to check the Department of Human Service’s COVID-19 website and the Department of Health’s website for updates. 

For provider enrollment, revalidation, enrollment fee, site visit or criminal background check questions please contact 1-800-537-8862, option 2, option 4, option 2. 

For question regarding claim payments please contact 1-800-537-8862, option 2, option 6, option 1.

To effectuate the above actions, CHIP is suspending CHIP Policy Transmittal 2018-01 Claims for Non-Enrolled Network Providers and CHIP Policy Clarification 2018-11 CHIP Provider Service Location Enrollment Deadline until the end of the public health emergency. 

Information on CHIP coverage related to COVID-19, including FAQ document, can be found on the CHIP website

Additional information is also available on the CDC website and through CMS

The Pennsylvania Department of Health has a dedicated page for COVID-19 that provides regular updates. Click here for the most up to date information regarding COVID-19. 

Next Steps

  1. Review the information in this policy clarification with appropriate staff. 
  2. Implement this policy clarification immediately.
  3. This policy clarification will remain in effect while a valid disaster declaration authorized by the Governor related to the COVID-19 virus remains in effect. The OOC may re-issue this policy clarification as appropriate.
  4. Questions concerning this transmittal should be directed to Virginia Perry CHIP Policy Director at (717) 585-2340 or via email at virperry@pa.gov