1. How do I access the PROMISe™ website?
Providers may access the PROMISe™ website for claim status, online claim submission, ePEAP, Eligibility Verifications, requesting Attachment Control Numbers, etc. at promise.DHS.state.pa.us. The first time you access this site, a short registration form must be completed using the 13-digit provider number, SSN or EIN number that is on your file. You will be required to create your own unique user ID and password, answer three challenge questions, select a site key token and enter a passphrase to complete the registration process. Once you have completed the registration form you may begin to submit claims, check recipient eligibility, etc. right away.
2. I have already registered at the PROMISe™ website, but I cannot get in. Why?
If this is a consistent issue, please contact the Provider Assistance Center for further assistance at 717-975-4100 or toll-free at 1-800-248-2152.
3. Where can I find a complete list of PROMISe™ provider types and specialties?
The Provider Type and Specialties list can be found here: Provider Types and Specialties
4. The PROMISe™ system requires a login/password. Will we be able to set up multiple passwords?
Providers may create alternate accounts for use by individuals within the provider's organization. Alternate accounts can be authorized by a provider to bill for more than one service location. The alternate is responsible for ensuring patient privacy. After creating a new alternate account, providers, out-of-network providers, and billing agents must supply the alternate with the unique four-digit PIN and five-digit Alternate Code generated during the alternate account creation process. The alternate is required to complete the registration process by creating their own unique user ID and password, answering three challenge questions, and selecting a site key token and passphrase.
5. As an administrator/employer of 25 physicians, all of whom have assigned their payments to our group, how can I become an authorized representative to keep all their locations and pay to addresses updated? Is there a way to do this as a group rather than get a sign-on for each individual physician?
You must initially login for each individual physician. However, you can then create an alternate account for each provider, without limitations or restrictions and toggle between the providers by using the Switch Provider feature without logging off and on for each provider. Complete instructions for creating alternate accounts can be found on the Home page of the PROMISe™ https://promise.DHS.state.pa.us/portal/Default.aspx?alias=promise.DHS.state.pa.us/portal/provider
1. May I limit the number of Medical Assistance (MA) patients I accept in my practice?
Yes. Providers may limit the number of MA patients they serve provided that limitation is not based on a factor which violates a recipient's civil rights as defined in Section 1405(b) of the Public Welfare Code (62 P.S. Section 1405(b)) and program regulations (55 PA Code §1101.51(b)). This regulation mandates that providers are prohibited from denying services or otherwise discriminating against any MA recipient. Providers should display in a prominent area, such as waiting room, their policy on accepting MA payment for services.
2. If I am an enrolled MA provider, but I am currently not accepting MA patients, may I accept an MA patient as a private pay patient?
No. Enrolled providers may not agree to accept an MA patient as a private pay patient. If an enrolled provider is not accepting MA patients, the provider should refer a recipient who requests services to his or her local County Assistance Office (CAO).
3. May I bill an MA recipient for Medicare coinsurance if the payment from Medicare exceeds the MA fee and no additional payment will be made by MA?
No. MA regulations in Chapter 1101, section 1101.63, and Section 4714 of the Balanced Budget Act of 1997 mandate that enrolled providers accept, as payment in full, amounts paid by the Department of Human Services for services rendered to eligible recipients. If Medicare or other third-party resource payment is involved, and payment from the resource exceeds the current MA fee, this regulation is still applicable and the provider may not seek additional payment, including deductible and/or coinsurance amounts from the recipient.
4. How long must I keep file copies of MA claims, insurance denials, copies of Remittance Advices, etc.?
At least four years.
5. Is there a phone number to call for questions regarding policy issues?
The Provider Inquiry unit is available to provide both billing and policy-related informational support. Phone numbers for the Provider Inquiry toll-free lines can be found at Contact Information/Help for MA Providers.