Quick Tips

Below are links to the PA Provider Quick Tips. These documents contain helpful tips for Medical Assistance providers and their staff.

223 - Availability of the Provider Directory on the Department of Human Services Website
222 - New Electronic Benefit Transfer Card
221 - Common Billing Issues Which May Result in Denied Claims as of July 2019
220 - Version 36 of All Patient Refined-Diagnosis Related Group (APR DRG) Implementation
219 - Service Location Enrollment Deadline
218 - Provider Enrollment File Information Changes
217 - Provider Enrollment Application Update
216 - Reminder: Hospital Adverse Determination Summary Requirement
215 - Payment Error Rate Measurement (PERM) Initiative for RY 2019
214 - Non-Emergency Ambulance Transportation
213 - Professional Claims Mapping of NPI for Rendering Providers
212 - Medicare and Medicare Advantage Crossover Claims for Certified Registered Nurse Practitioners (CRNP) and Physician Assistants (PA)
211 - Medical Assistance (MA) Update for ASC X12N 276/277 (Claim Status Inquiry/Claim Status Response)
210 - Version 35 of All Patient Refined-Diagnosis Related Group (APR DRG) Implementation
209 - Crossover Claims - Qualified Medicare Beneficiary (QMB) Program CARC 209 and Cost Sharing*
208 - Crossover Claims - Ordering and Referring Providers
207 - MA Program Fee Schedule Updates for Act 62 Procedure Codes
206 - Medical Assistance Phone Options Update
205 - Mid-Level Practitioner - Provider Electronic Portal Update
204 - IMPORTANT MESSAGE: Claims Submitted by Billing Providers Must Contain the National Provider Identifier (NPI) of the Medical Assistance (MA)
Enrolled Ordering, Referring or Prescribing Provider
203 - Provider Electronic Solutions (PES) Mandatory Upgrade Available March 17, 2017
202 - Version 34 of All Patient Refined-Diagnosis Related Group (APR DRG) Implementation
201 - Medical Assistance (MA) Fee Schedule Updates for Certain Family Planning Services
200 - Valid Zip Code On Electronic Claims and Encounters
199 - Ordering, Referring or Prescribing Providers
198 - Medical Assistance (MA) Provider Groups Must Be Revalidated
196 - Electronic Provider Enrollment Application "Copy" Function Released
195 - Additional Information on the Provider Enrollment Application Fee
194 - Enrollment of Physician Assistants
193 - Updated List of Providers Unable to Apply via the Electronic Provider Portal
192 - Observation Services
191 - Reporting of Pregnancy On All Claim Types
190 - Announcing the Electronic Provider Enrollment Application
189 - Version 33 of All Patient Refined-Diagnosis Related Group (APR DRG) Implementation
188 - Revised Procedures for Presumptive Eligibility as Determined by Hospitals
187 - Valid ICD-10 Diagnosis Required on Laboratory Claims
186 - Reminder: Diagnosis Qualifier Required for Professional and Institutional Claims
185 - ICD-10 Prior Authorizations
184 - ICD-10 Span Date Billing for Outpatient and Professional Services
183 - ICD-10 and Atypical Providers
182 - ICD-10 Claims Compliance Date
181 - Provider Electronic Solutions (PES) New Version Available August 31, 2015
180 - Affordable Care Act (ACA) Provider Revalidation of All Provider Types Including All Associated Service Locations
179 - Version 31 of All Patient Refined-Diagnosis Related Group (APR DRG) Effective July 1, 2015
178 - Payment Error Rate Measurement (PERM) Initiative for FFY 2015
177 - Medicare Dual Eligible Claims with Duplicate CARC (Claim Adjustment Reason Code) CO 237
176 - Presumptive Eligibility for Pregnant Women - 2019 Income Limits
175 - Incomplete Provider Enrollment Applications will be Returned Effective February 1, 2015
174 - Limits on Medical-Surgical Consultations During Inpatient Stay
173 - All Medical Assistance (MA) Providers MUST Enroll & Update all Service Locations with the Department of Human Services (the department) as Well as Providers With Managed Care Organizations (MCOs)
172 - Announcing Provider Revalidation Date Fields on Your Provider Profile
171 - ICD-10 Checklist Get Ready! Less than 70 Days Left Before the Mandatory 10/1/2015 Implementation Date (Revised July 2015)
170 - Medicare Sequestration Payment Reductions on All Claims Media Fee-for-Service (FFS) Claims
169 - Department of Human Services (the department) Breast and Cervical Cancer Prevention and Treatment (BCCPT) Program Mailing address change for the BCCPT Renewal Form
168 - Provider Enrollment Application Requirement
167 - Electronic Enrollment for Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA)
166 - Addenda Record for Electronic Funds Transfer (EFT)
164 - Most Common Billing Errors for Drugs Covered Under the Medical Assistance (MA) Program
163 - Electronic Remittance Advice (ERA) Delivery Date Change
162 - Revised CMS-1500 Form (02/12)
161 - Medicare Sequestration Reductions on Fee-for-Service (FFS) Claims Processing and Related Clarification of Medical Assistance (MA) 539 Form (11/13) Usage
160 - Health Insurance Portability and Accountability Act of 1996 (HIPAA) Upgrade to ICD-10 Diagnosis & Surgical Procedure Codes is Coming! Get Ready! (revised September 30, 2015)
159 - Implementation of American Dental Association (ADA) Claim Form - Version 2012
158 - Provider Enrollment Application Requirement
157 - Hospital Payment Arrangement 1 and 2 for Emergency Room
156 - Provider Electronic Solutions (PES) Software v3.60 Replaces v3.59
155 - Announcing the New Medical Assistance (MA) Enrolled Provider Portal Lookup Function
154 - Centers for Medicare and Medicaid Services (CMS) Creates New Medicaid National Correct Coding Initiative (NCCI) Procedure-to-Procedure Edits Related to Wheelchairs Effective October 1, 2012
153 - Pennsylvania (PA) Medical Assistance (MA) Clinical Laboratory Improvement Amendments (CLIA) Requirements
152 - Medical Assistance (MA) Increased Fees for Primary Care Services for Calendar Years 2013-2014, Physician Provider Type 31, Provider Specialties 316, 322 & 345
151 - Name Change for AmeriHealth Mercy Health Plan and Keystone Mercy Health Plan
150 - Provider Enrollment Application Requirement effective January 21, 2013
149 - Billing of Multiple Anesthesia Services
148 - CAQH/CORE Changes to 270/271 Eligibility Transactions
146 - Statewide Obstetrical Needs Assessment Form (ONAF) Update
145 - The ACCESS Card is not Going Away
144 - Eligibility Verification System (EVS) Search Enhancement
143 - Medical Assistance (MA) Providers and Managed Care Organizations (MCOs) Must Ensure Continuity of Care During HealthChoices (HC) New East Zone Expansion
142 - HealthChoices Physical Health Expansion to the New East Zone March 2013
141 - Delaying the Copay for Alternative Cost Sharing for Families of Children with Disabilities with Incomes Over 200% of the Federal Poverty Income Guidelines
139 - Attention Medical Assistance (MA) Dental Providers
138 - Medical Assistance (MA) Providers and Managed Care Organizations (MCOs) Must Ensure Continuity of Care During HealthChoices (HC) Expansion
137 - Billing of Multiple Surgical Services
136 - Billing Primary Procedure Code with Add-on Code(s)
135 - HealthChoices Physical Health Expansion to the New West Zone
134 - Low-Cost Outlier Implementation and High-Cost Outlier Threshold Adjustment
133 - Emergency Supply of a Prescription That Requires Prior Authorization (PA) or a Benefit Limit Exception (BLE)
132 - Updates to the Medical Assistance (MA) Program Fee Schedule for Hospital Based Clinic Services
131 - Miscellaneous Healthcare Common Procedure Coding System (HCPCS) Procedure Codes B9998, E1399 and K0108 with Specific Modifiers Are Assigned to Distinct Items on the Medical Assistance (MA) Program Fee Schedule
130 - The ANSI X12 v5010/D.0 Certification Help Desk will be Discontinued as of March 30, 2012
128 - Non-Emergency Ambulance Transportation – Appropriate Use of Place of Service (POS) and Modifier for Nursing Facility Recipients
127 - Provider Electronic Solutions (PES) Software v3.59 replaces v3.58
126 - HealthChoices is Expanding to your County in 2012
125 - Reporting Ambulance Pick-up/Drop-Off Point of Service
123 - Medical Assistance (MA) Claims for Ambulance Transport to Inpatient Hospital Facilities
122 - Medical Assistance (MA) Outpatient Online Fee Schedule
121 - Certification Renewal Required for Medical Assistance (MA) Providers Dispensing Hearing Aid Supplies (revised February 2019)
120 - Waiving of the Certification Requirements for ANSI X12 v5010 and NCPDP D.0 for current electronic claim submitters
119 - PROMISe™ Internet Adjustments, Voids and Resubmissions Beginning January 1, 2012
117 - Medical Assistance (MA) Phone Number Changes
116 - Compliance Date for ANSI X12 v5010/NCPDP vD.0 IS January 1, 2012; Pennsylvania will Implement January 1, 2012
115 - Medical Assistance Inpatient Hospital Claims Secondary to Medicare Include 3 Day (72 hour) Payment Rule
114 - Fee-For-Service Relative Weight Adjustment
113 - Changes to Diagnosis Code Edits
112 - Reprocessing Procedure Code 90999 Claims
111 - Discontinued Mailing of Medical Assistance Bulletins
110 - Medical Assistance Dental Benefit Changes
109 - Is it Necessary to Certify for X12 v5010 Transactions?
108 - Pediatric Palliative and Hospice Care Task Force
107 - Medical Assistance Health Information Technology Initiative Electronic Health Record Incentive Program
106 - PES Software Upgrade
105 - APR-DRG Implementation to Begin on 3-4-11
104 - 2-25-11 APR-DRG Implementation DELAYED
103 - 1099-MISC - Information for Providers
102 - As DHS Moves from DRG to APR DRG
100 - ANSI v5010/NCPDP D.0 Recertification
98 - Providing Services for Recipients who are Locked-In to a Physician, Pharmacy or Hospital
96 - New Web Site Coming in October!
95 - Clarification on the Change in Protocol for Certain Provider Appeals
94 - Pennsylvania PROMISe ANSI X12 v5010 Companion Guides
92 - PROMISe™ New Internet Portal
91 - PROMISe Certification for ANSI 5010 and NCPDP D.0
89 - HIPAA Upgrades to ANSI X12 v5010 & NCPDP D.0 are coming! Get Ready!
87 - Medical Assistance (MA) Providers are reminded to make sure MA contact information is up to date
85 - Department of Human Services (DHS) Breast and Cervical Cancer Prevention and Treatment Program (updated February 2019)
84 - HCBP 15 SelectPlan for Women Provides Limited Coverage
82 - Reminder to Medical Assistance (MA) Providers Filing National Provider Identifier (NPI) Electronic Claims
81 - Copayment Desk Reference Clarification
80 - Attention: All Healthy Beginnings Plus Providers
79 - ICD-9 Codes E849.0 - E849.9 (Place of Occurrence)
77 - Medicaid Integrity Contractor (MIC) Audits
76 - Reporting Diagnosis Codes for Immunization Administration
75 - Pennsylvania PROMISe - 835 Remittance Advice Companion Guide
74 - Diagnosis Codes are Required on Most Medical Assistance Claims
72 - National Provider Identifier (NPI) Requirements For Electronic Claims
71 - The Department of Human Services (DHS) Encourages Providers to go Electronic and Support the Go Green Initiative!
69 - Medical Assistance (MA) Claims for Advanced Radiologic Imaging Services
68 - Using the 50 Modifier on Medical Assistance Claims
67 - Prior Auth. Requirements for Effective Non-Fee Schedule Surgical Procedures Effective Aug. 1, 2008
66 - Early Periodic Screening, Diagnosis & Treatment (EPSDT) & Error Status Code 771
65 - Early & Periodic Screening, Diagnosis & Treatment (EPSDT) Billing Assistance for FQHCs
64 - For Medical Assistance (MA) Providers Submitting MA Claims For Prior Authorized Services
63 - Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Billing Assistance
62 - NPI and Paper Claim forms: CMS-1500 (Professional)& UB-04 (Institutional)
60 - Place of Service Review (PSR) requests for Short Procedure Units (SPUs)
59 - Information For Healthy Beginnings Providers
56 - Most Common Errors Made On the Prior Authorization / MA 97 Form
55 - Federal Requirements for Outpatient Drug Prescriptions for MA Recipients
53 - Electronic Funds Transfer (EFT) Sign Up Today!!
52 - MA Recipient Drug Prescriptions Must be Written on Tamper-Resistant Prescription Pads
51 - Dental Behavior Management Billing Reminders
47 - Attention: DME Suppliers, Independent Labs, and Mobile X-Ray Providers
46 - Attention, New Healthcare Providers Requesting Medical Assistance (MA) Enrollment
45 - National Provider Identifier (NPI) Legacy Dual Strategy
44 - Correctly Reporting Value Codes on the UB-04 Claim Form to Ensure Smooth Claims Processing
43 - Now Receive Medical Assistance (MA) Bulletin Notifications Via Email!
42 - Eligibility Verification System (EVS) Reminder
41 - Medical Assistance Desk Reference Guide (Updated August 2018)
40 - New Downloadable Outpatient Fee Schedule
39 - Provider Data Elements Expected on HIPAA-Covered Transactions
38 - Attention, All Healthcare Providers: You MUST Register an NPI Number with DHS
35 - The PROMISe Outpatient Fee Schedule is Online
32 - Atypical Providers
31 - New Option on ePeap!
27 - National Provider Identifier (NPI) Taxonomy Codes
26 - Securing National Provider Identifier (NPI) Numbers for Subparts
25 - Access Plus Referral Requirements Effective November 1, 2006
24 - NPI and Paper Claim Forms
23 - Federal Medicaid Citizenship and Identity Eligibility Requirements
21 - You Can Stop Receiving Paper Remittance AS (RAs)
17 - Scope of Coverage of Pharmacy Services: Medical Assistance Dual Eligibles
15 - Copayments for Prescription Drugs
12 - Do You Need to Send an Attachment for an Electronic Claim?
11 - The Eligibility Verification System (EVS)
10 - ePEAP (electronic Provider Enrollment Automation Project)
07 - Are You Puzzled by Your Remittance Advice Statement?

Long Term Living Providers

01 - General Information
02 - UB-04 Questions & Answers
03 - Billing Questions and Answers
04 - Medicare Questions and Answers
05 - PES (Provider Electronic Solutions Software)

Government that Works
Increase access to health care
Jobs that Pay
Develop a skilled workforce that meets the needs of Pennsylvania's business community
Schools that Teach
Provide universal access to high-quality early childhood education
Government that Works
Provide high-quality supports and protections to vulnerable Pennsylvanians

Schools That Teach
Jobs That Pay
Government That Works

​Quick Tips

Long Term Living Providers

Governor's Goals

Government that Works

Jobs that Pay

Schools that Teach

Government that Works

Quick Tips