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​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)