You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page.
Turn on more accessible mode
Turn off more accessible mode
Skip Ribbon Commands
Skip to main content
Turn off Animations
Turn on Animations
SharePoint
Sign In
To navigate through the Ribbon, use standard browser navigation keys. To skip between groups, use Ctrl+LEFT or Ctrl+RIGHT. To jump to the first Ribbon tab use Ctrl+[. To jump to the last selected command use Ctrl+]. To activate a command, use Enter.
Browse
Tab 1 of 3.
Library Tools
Files
Library Tools group. Tab 1 of 2.
Library
Library Tools group. Tab 2 of 2.
Follow
Sync
Department of Human Services
Services
Assistance
Assistance
Cash Assistance
COMPASS
Diversion Program
Domestic Violence
Early Learning Resource Centers
Employment and Training
Find Facilities
Housing
Legal Help
LIHEAP
Medical Assistance
Rape Crisis and Prevention
Refugee Cash Assistance Program
State Blind Pension Program (SBPP)
SNAP
State Hospitals
Substance Abuse
TANF
Welfare Fraud
Children
PACTT
Child Support Contact
Child Welfare Services
Integrated Children's Services
Juvenile Justice
Child Care Early Learning
Early Intervention Forms
Early Intervention Laws and Regulations
OSEP Reporting
5 Step Child Care
Child Care Works Program
Head Start
Parent Resources
STARS for Parents
Adoption in PA
Foster Care PA
Forestry Programs
Child Health Services
PREA
Treatment Approaches and Planning
Disabilities & Aging
Disabilities & Aging
Alternatives to Nursing Homes
Assistive Technology
Autism Services
Intellectual Disabilities Services
LIFE
Long Term Care Services
Personal Care Homes
Services for Persons with Disabilities
State Centers
Aging Waiver
Attendant Care Waiver
Consumer Directed Services (CDS)
Independence Waiver
Nursing Home Transition (NHT)
OBRA
Specialized Service
Adult Autism Waiver (AAW)
ACAP
Act 62
Mental Health in PA
Adults and Older Adults
Children and Adolescents
Guiding Principles
Mental Health Planning Council
MHSIP
OMHSAS Information
Resources
Child and Adolescent Service System Program
A Call for Change
Autism
Enrollment and Payment
Training and Supervision Requirements
Fetal Alcohol Spectrum Disorders
2011 OMHSAS Call to Action: Fetal Alcohol Spectrum Disorder
PA FASD Task Force
Juvenile Justice-Related Services
School-Based Behavioral Health
Assertive Community Treatment
ACT in PA
ACT Fidelity Cost and Outcomes
Mass Care and Emergency Assistance
Other Services
Burial and Cremation
Casualty Recovery
Estate Recovery
Homeless Assistance
Reproductive Health
Act 2008-44
ET Resources
PROMISe Certification
Tristani v. Richman
TPL Web Portal
Find a Document
For Providers
Act 21 Forms
Behavioral Health Services
Bureau of Hearings and Appeals Non-Formal Provider Appeals
Child Care Forms
Personal Care Home Reports
PROMISe Companion Guides
PROMISe Desk Reference
Regulations Handbooks Guides and Manuals
Remittance Advice Alerts PROMISe Banner Pages
State Hospital Risk Management Summary
Bulletin Search
Medical Assistance Regulations
Publications
Access Monitoring Plan
Budget Information
Bureau of Hearings and Appeals Forms
Child Abuse Reports
Child Fatality Near Fatality Reports
Child Youth and Family Service Plan
Everyday Lives
Final Performance Audit Reports
Highlighted Reports
Infographics
Medicaid State Plan
OCYF Reports
Personal Care Homes Monthly Report
Policy Handbooks and Manuals
Bulletin List
Form Search
Quarterly Summaries Child Abuse
Archived Manuals
Family Support Needs Assessment
OIM Recent Ops Memos PCs
The Impact
Forms
About
DHS Online Services
DHS Leadership
Data Dashboards
Fraud and Abuse
CAP Guidelines
Credit Balance Self Review
Health Care Compliance Plans
MA Fraud and Abuse - General Information
MA Provider Compliance Hotline
MA Provider Self Audit Protocol
Medicheck List
MIC Initiative
Post and Prepayment Review
Privacy Policy
RAC Providers Review
Adult Protective Services
APS Media Toolkit
Priorities
ECM Enterprise Case Management
Contact Us
Helpful Phone Numbers
Feedback Form
DHS Offices
OCYF-Bureau of Budget and Fiscal Support
OCYF-Bureau of Child and Family Services
OCYF-Bureau of Juvenile Justice Services
OCYF-Bureau of Policy Programs and Operations
CWIS
OCDEL-Bureau of Certification Services
OCDEL-Bureau of Early Intervention Services
OCDEL-Bureau of Policy and Professional Development
OCDEL-Operations and Monitoring
OCYF
ODP-HCBS Final Rule
ODP-Bureau of Autism Services
ODP-Bureau of Financial Management and Program Support
ODP-Bureau of Policy and Quality Management
ODP-Bureau of Community Services
Developmental Disabilities Council
STARS
OIM-Bureau of Child Support Enforcement
OIM-Bureau of Employment Programs
OIM-Bureau of Operations
County Assistance Offices
DHS Press Office
Text Messaging
For Providers
Currently selected
Sort by Industry
Clearances and Licensing
Clearances and Licensing
App for License
Assisted Living Residence Licensing
Children and Youth Residential Licensing
Developmental Programs Licensing
Mental Health Programs Licensing
Personal Care Home Licensing
Licensing Webinars
Licensing General Training Information
MH-Licensing-Regulations-Standards
MH-Licensing-Related-Resources
MH-Licensing-New-Provider-Information
MH-Licensing-Compliance-FAQ
Behavioral Health Telehealth
FAQs
Helpful Links
1099 Information
ACCESS EVS FAQ
Behavioral Health FAQ
Billing and Claims FAQ
Checks Payment Remittance FAQ
Claim Check FAQ
Enrollment Provider File FAQ
Forms Invoices Handbooks FAQ
NPI FAQ
Nursing Facility FAQ
Nursing Facility Medicare Part D Questions
Prior Authorization FAQ
PROMISe FAQ
CHIP
About CHIP
What is CHIP?
CHIP History
Reasons To Be Insured
CHIP Enrollment
CHIP Coverage
CHIP Coverage
CHIP Insurance Companies
CHIP Resources
CHIP FAQs
CHIP E-Toolkit
Order CHIP Materials
Annual Reports
Advisory Council
Contact Us
Eligibility and Benefits
Apply For CHIP
Renew Coverage
Information for Grandparents
Information for Immigrants
Success Stories
Co-Parenting Services
Statewide Resources
County Resources
COVID-19 Vaccine
Vaccine Distribution Data
Educational Resources
COVID-Vaccine-FAQ
ECM
About ECM
About ECM
ECM Graphic
Governance
Subsystems
Development
Development Home
Phases
User Story Sessions
Individuals/Participants
Those We Serve
Hearings & Appeals
Long-Term Living
Autism & Intellectual Disabilities
Child Development and Early Learning
Mental Health & Substance Abuse
Children, Youth, & Families
Managing Change & Training
Change & Training Home
What does ECM mean to me
News
Major Vendor Announcements
Historic Information
Stakeholders
Stakeholders Home
Administrative Entities
County Organizations
Hearings & Appeals
Program Areas
Providers
Service/Supports Coordinators
Those We Serve
Other Groups
Subsystems
Home and Community-Based Services Subsystem
Hearings & Appeals Subsystem
Office of Long-Term Living Enrollment Services
Child Welfare Case Management
ECM FAQ
Contact ECM
Coming Soon
ERAP
ERAP Media Kit
ERAP Reports and Resources
ERAP Dashboard
Test Troubleshoot
fnfdct
PA Link to Community Care
Advocacy
Health Care
Meals
Behavioral Health
Housing
Protection From Abuse
Employment
In-Home Services
Support Groups
Financial Help
Legal Help
Transportation
Publications
Apply To Be Listed
RISE-PA
We Can Work
Work Without Losing Benefits
Your Employment Services
Find a Job
Success Stories
Medical Assistance & CHIP Renewals
Communications Toolkit
Helpers
Glossary
Medical Assistance & CHIP Renewals FAQs
Individual Communications
Videos & Webinars
PROOF-HP-Redesign
Unwinding Renewals Progress Tracker
Documents
This system library was created by the Publishing feature to store documents that are used on pages in this site.
It looks like your browser does not have JavaScript enabled. Please turn on JavaScript and try again.
About
Contact Us
Find a Document
For Providers
Sort by Industry
Clearances and Licensing
FAQs
Promise Handbooks
Currently selected
Services
CHIP
Co-Parenting Services
COVID-19 Vaccine
ECM
ERAP
fnfdct
PA Link to Community Care
RISE-PA
We Can Work
Medical Assistance & CHIP Renewals
Type
Name
Modified
Modified By
Checked Out To
837 Dental ADA Version 2012 Claim Form
8/6/2021 11:29 AM
System Account
837 Institutional UB-04 Claim Form
1/7/2020 5:39 PM
System Account
837 Professional CMS 1500 Claim Form
10/7/2021 3:18 PM
System Account
ADA Claim Form – Version 2012 Completion Aid for Dentists (2)
1/7/2020 5:39 PM
System Account
ADA Claim Form – Version 2012 Completion Aid for Dentists
1/7/2020 5:39 PM
System Account
ADA Claim Form V 2012 Completion Aid for Dentists
1/7/2020 5:39 PM
System Account
ADA Claim Form Version 2012 Completion Aid for Dentist
1/7/2020 5:39 PM
System Account
ADA Claim Form Version 2019 Completion Aid for Dentist
9/27/2022 12:00 PM
System Account
appendix E
1/7/2020 5:39 PM
System Account
c_208895_Therapists
1/7/2020 5:39 PM
System Account
CMS 1500 02-12 Billing Guide for PROMISe Adult Autism Waiver ICD-10 Version
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Aging Waiver
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Ambulance Providers
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Attendant Care Providers
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Audiologists
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Birthing Centers
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Case Managers
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Chiropractors
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe COMMCARE Waiver Services
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe CRNAs
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe CRNP
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Family Planning Councils TITLE XIX only
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe FMS
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Funderal Directors
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Healthy Beginning Plus Providers
10/1/2021 9:01 AM
System Account
CMS 1500 Billing Guide for PROMISe Home and Community Habilitation Providers
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Home Health Agencies
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Home Residential Rehabilitation Providers
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Homemaker Agency Providers
1/7/2020 5:39 PM
System Account
CMS 1500 Billing Guide for PROMISe Hospice Providers
1/7/2020 5:39 PM
System Account
Compliance Details
javascript:commonShowModalDialog('{SiteUrl}'+ '/_layouts/15/itemexpiration.aspx' +'?ID={ItemId}&List={ListId}', 'center:1;dialogHeight:500px;dialogWidth:500px;resizable:yes;status:no;location:no;menubar:no;help:no', function GotoPageAfterClose(pageid){if(pageid == 'hold') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ '/_layouts/15/hold.aspx' +'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'audit') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ '/_layouts/15/Reporting.aspx' +'?Category=Auditing&backtype=item&ID={ItemId}&List={ListId}'); return false;} if(pageid == 'config') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+ '/_layouts/15/expirationconfig.aspx' +'?ID={ItemId}&List={ListId}'); return false;}}, null);
0x0
0x1
ContentType
0x01
898
Document Set Version History
/_layouts/15/images/versions.gif?rev=23
javascript:SP.UI.ModalDialog.ShowPopupDialog('{SiteUrl}'+ '/_layouts/15/DocSetVersions.aspx' + '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
330
Send To other location
/_layouts/15/images/sendOtherLoc.gif?rev=23
javascript:GoToPage('{SiteUrl}' + '/_layouts/15/docsetsend.aspx' + '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
350