12/06/2024
- Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
12/04/2024
- Added Managed Care Enrollment Information: October 2024
11/21/2024
- Added Remittance Advice Dates – December 2024 Remittance Advice Date
11/19/2024
- 99-24-09 A Medical Assistance Bulletin entitled Medical Assistance Program Vaccine Desk Reference Updates
11/14/2024
Added MA Bulletins numbered:
- 01-25-31 A Medical Assistance Bulletin entitled Prior Authorization of Thrombopoietics - Pharmacy Services
- 01-25-32 A Medical Assistance Bulletin entitled Prior Authorization of Ulcerative Colitis Agents - Pharmacy Services
11/13/2024
Added MA Bulletins numbered:
- 01-25-25 A Medical Assistance Bulletin entitled Prior Authorization of Phosphate Lowering Agents (Formerly Phosphate Binders) - Pharmacy Services
- 01-25-26 A Medical Assistance Bulletin entitled Prior Authorization of Pulmonary Hypertension Agents, Oral and Inhaled - Pharmacy Services
- 01-25-27 A Medical Assistance Bulletin entitled Prior Authorization of Skeletal Muscle Relaxants - Pharmacy Services
- 01 25-28 A Medical Assistance Bulletin entitled Statewide Preferred Drug List (PDL) Updates - Pharmacy Services
- 01-25-29 A Medical Assistance Bulletin entitled Prior Authorization of Stimulants and Related Agents - Pharmacy Services
- 01-25-30 A Medical Assistance Bulletin entitled Prior Authorization of Thalidomide and Derivatives - Pharmacy Services
11/12/2024
Added MA Bulletins numbered:
- 01-25-12 A Medical Assistance Bulletin entitled Prior Authorization of Colony Stimulating Factors - Pharmacy Services
- 01-25-16 A Medical Assistance Bulletin entitled Prior Authorization of Immunomodulators, Atopic Dermatitis - Pharmacy Services
- 01-25-17 A Medical Assistance Bulletin entitled Prior Authorization of Lipotropics, Other - Pharmacy Services
- 01-25-21 A Medical Assistance Bulletin entitled Prior Authorization of Natalizumab - Pharmacy Services
- 01-25-23 A Medical Assistance Bulletin entitled Prior Authorization of Oncology Agents, Oral - Pharmacy Services
- 01-25-24 A Medical Assistance Bulletin entitled Prior Authorization of Pancreatic Enzymes - Pharmacy Services
11/08/2024
Added MA Bulletins numbered:
- 01-25-11 A Medical Assistance Bulletin entitled Prior Authorization of Botulinum Toxins - Pharmacy Services
- 01-25-10 A Medical Assistance Bulletin entitled Prior Authorization of Antipsychotics - Pharmacy Services
- 01-25-09 A Medical Assistance Bulletin entitled Prior Authorization of Antiparkinson’s Agents - Pharmacy Services
- 01-25-08 A Medical Assistance Bulletin entitled Prior Authorization of Monoclonal Antibodies (MABs) – Anti-IL, Anti-IgE, Anti-TSLP - Pharmacy Services
- 01-25-07 A Medical Assistance Bulletin entitled Prior Authorization of Antifibrotic Respiratory Agents - Pharmacy Services
- 01-25-04 A Medical Assistance Bulletin entitled Prior Authorization of Anticonvulsants - Pharmacy Services
11/07/2024
Added MA Bullletins:
- 01-25-03 Medical Assistance Bulletin entitled Prior Authorization of Analgesics, Opioid Short-Acting – Pharmacy Services
- 01-25-02 Medical Assistance Bulletin entitled Prior Authorization of Analgesics, Opioid Long-Acting – Pharmacy Services
- 01-25-01 Medical Assistance Bulletin entitled Prior Authorization of Analgesics, Non-Opioid Barbiturate Combinations – Pharmacy Services
Added MA Bulletins numbered:
- 01-25-05 A Medical Assistance Bulletin entitled Prior Authorization of Antidepressants, Other - Pharmacy Services
- 01-25-06 A Medical Assistance Bulletin entitled Prior Authorization of Antidepressants, SSRIs - Pharmacy Services
- 01-25-22 A Medical Assistance Bulletin entitled Prior Authorization of Neuropathic Pain Agents - Pharmacy Services
11/06/2024
Added MA Bulletins numbered:
- 01-25-13 A Medical Assistance Bulletin entitled Prior Authorization of Cytokine and CAM Antagonists - Pharmacy Services
- 01-25-14 A Medical Assistance Bulletin entitled Prior Authorization of Hepatic and Biliary Agents (formerly Bile Salts) - Pharmacy Services
- 01-25-15 A Medical Assistance Bulletin entitled Prior Authorization of Hereditary Angioedema (HAE) Agents - Pharmacy Services
- 01-25-18 A Medical Assistance Bulletin entitled Prior Authorization of Migraine Acute Treatment Agents - Pharmacy Services
- 01-25-19 A Medical Assistance Bulletin entitled Prior Authorization of Migraine Prevention Agents - Pharmacy Services
- 01-25-20 A Medical Assistance Bulletin entitled Prior Authorization of Multiple Sclerosis Agents - Pharmacy Services
11/04/2024
11/01/2024
Added MA Bulletins numbered:
- 08-24-16 A Medical Assistance Bulletin entitled Updates to The PROMISe™ Provider Handbook 837 Professional/CMS-1500 Claim Form, Appendix E – FQHC/RHC Handbook
10/29/2024
Added MA Bulletins numbered:
- 99-24-08 A Medical Assistance Bulletin entitled Pennsylvania’s Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
10/24/2024
- Added Managed Care Enrollment Information: September 2024
10/18/2024
- Added Remittance Advice Dates – November 2024 Remittance Advice Date
10/16/2024
Added MA Bulletins numbered:
- 08-24-15 A Medical Assistance Bulletin entitled Federally Qualified Health Center and Rural Health Clinic Payment for SARS-CoV-2 Vaccine Administration
09/25/2024
- Added Managed Care Enrollment Information: August 2024
09/19/2024
- Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
09/17/2024
- Added Remittance Advice Dates – October 2024 Remittance Advice Date
09/16/2024
Added MA Bulletins numbered:
- 99-24-06 A Medical Assistance Bulletin entitled MA Program Fee Schedule Updates for Certain Ophthalmology Procedure Codes
- 35-24-01 A Medical Assistance Bulletin entitled School-Based ACCESS Program Provider Handbook
09/09/2024
Added MA Bulletins numbered:
- 99-24-07 A Medical Assistance Bulletin entitled Medical Assistance (MA) Program Fee Schedule Revisions
- 01-24-13 A Medical Assistance Bulletin entitled MA Program Fee Schedule Updates For Certain Family Planning Procedure Codes
09/06/2024
- Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
09/04/2024
08/26/2024
- Added Managed Care Enrollment Information: July 2024
08/23/2024
Added MA Bulletins numbered:
- 05-24-01 A Medical Assistance Bulletin entitled Updated Electronic Visit Verification Manual Edits Compliance Percentage Requirements in the Fee-for-Service Delivery and Managed Care Delivery Systems
08/20/2024
- Added Remittance Advice Dates – September 2024 Remittance Advice Date
08/7/2024
Added MA Bulletins numbered:
- 01-24-11 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, Incretin Mimetics/Enhancers – Pharmacy Services
- 01-24-12 A Medical Assistance Bulletin entitled Prior Authorization of Obesity Treatment Agents – Pharmacy Service
07/31/2024
- Added Managed Care Enrollment Information: June 2024
- Updated Provider Quick Tip #41 - Medical Assistance Desk Reference Updated July 2024
07/25/2024
- Updated Provider Quick Tip #85 - Department of Human Services (DHS) Breast & Cervical Cancer Prevention & Treatment (BCCPT) Program Updated July 2024
07/17/2024
- Added Remittance Advice Dates – August 2024 Remittance Advice Date
07/08/2024
- Added MA Bulletins numbered:
07/02/2024
- Added MA Bulletins numbered:
- 01-24-07 A Medical Assistance Bulletin entitled - Prior Authorization of Lyfgenia (lovotibeglogene autotemcel) – Pharmacy Services
- 01-24-08 A Medical Assistance Bulletin entitled - Prior Authorization of Zynteglo (betibeglogene autotemcel) – Pharmacy Services
- 01-24-09 A Medical Assistance Bulletin entitled - Prior Authorization of Antidepressants, Other – Pharmacy Services
- 01-24-10 A Medical Assistance Bulletin entitled - Prior Authorization of Casgevy (exagamglogene autotemcel) – Pharmacy Services
06/28/2024
- Added Managed Care Enrollment Information: May 2024
- Updated Pennsylvania Medicaid Managed Care Directory
06/26/2024
- ·Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
- Updated Provider Quick Tip - The following Quick Tip has been added to the website.
06/21/2024
- Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
06/20/2024
- Added Remittance Advice Dates – July 2024 Remittance Advice Date
06/05/2024
- Added MA Bulletins numbered: 27-24-03 A Medical Assistance Bulletin entitled - 2024 Medical Assistance Program Dental Fee Schedule Update
06/03/2024
- Updated Provider Quick Tip #207 - MA Program Fee Schedule Updates for Act 62 Procedure Codes
05/28/2024
- Added MA Bulletins numbered:
- 99-24-03 A Medical Assistance Bulletin entitled - 2024 Healthcare Common Procedure Coding System (HCPCS) Updates, Fee Adjustments, and Other Procedure Code Changes
- 01-24-06 A Medical Assistance Bulletin entitled - Updates to the Family Planning Services Program Fee Schedule
05/22/2024
- Added Provider Quick Tips — The following Quick Tips have been added to the website
- #274 — Ambulance Services Update
05/21/2024
- Added Remittance Advice Dates – June 2024 Remittance Advice Date
- Added Managed Care Enrollment Information: April 2024
05/10/2024
- Updated Provider Quick Tips - The following Quick Tips have been added to the website.
#176 - Presumptive Eligibility for Pregnant Women - 2024 Income Limits
05/03/2024
- Added Technology Assessment Group information to the website. Technology Assessment Group
05/01/2024
- Added Managed Care Enrollment Information: March 2024
- Updated Pennsylvania Medicaid Managed Care Directory
04/29/2024
- Added MA Bulletin numbered:
99-24-02 A Medical Assistance Bulletin entitled Medical Assistance (MA) Program Fee Schedule Revisions
04/18/2024
- Added MA Bulletin numbered:
26-24-01 A Medical Assistance Bulletin entitled Ambulance Services
04/16/2024
- Added MA Bulletins numbered: 99-24-04 A Medical Assistance Bulletin entitled 2024 Recommended Child and Adolescent Immunization Schedule
- Added Remittance Advice Dates – May 2024 Remittance Advice Date
04/10/2024
- Added MA Bulletin numbered:
01-24-04 A Medical Assistance Bulletin entitled Over-the-Counter Oral Contraceptives
04/05/2024
Added Provider Quick Tip — The following Quick Tip has been added to the website.
03/25/2024
Added Provider Quick Tip — The following Quick Tip has been added to the website.
03/21/2024
- Added Managed Care Enrollment Information: Added February 2024
- Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
03/20/2024
- Added Remittance Advice Dates – April 2024 Remittance Advice Date
03/05/2024
- Added Managed Care Enrollment Information: Added January 2024
03/04/2024
- Added Remittance Advice Dates - March 2024 Remittance Advice Date
03/1/2024
- Added MA Bulletins numbered:
08-24-04 A Medical Assistance Bulletin entitled Updates to The PROMISe™ Provider Handbook837 Professional/CMS-1500 Claim Form,Appendix E – FQHC/RHC Handbook
02/14/2024
- Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
02/13/2024
- Added MA Bulletins numbered:
01-24-01 A Medical Assistance Bulletin entitled Pharmacist Billing
02/06/2024
- Added MA Bulletins numbered:
01-24-03 A Medical Assistance Bulletin entitled Prior Authorization of Opioid Use Disorder Treatments – Pharmacy Services
02/01/2024
- Added MA Bulletins numbered:
10-24-02 A Medical Assistance Bulletin entitled Pharmacist Enrollment in the Medical Assistance Program
01/24/2024
- Added MA Bulletins numbered:
99-24-01 A Medical Assistance Bulletin entitled Medical Assistance Program Vaccine Desk Reference
01/22/2024
- Added Managed Care Enrollment Information:
Added December 2023
01/19/2024
- Added MA Bulletins numbered:
01-24-02 A Medical Assistance Bulletin entitled Pasteurized Donor Human Milk Coverage Updates
01/12/2024
- Added Remittance Advice Dates - February 2024 Remittance Advice Date
- Added Updated Pennsylvania Medicaid Managed Care Directory
01/10/2024
- Added MA Bulletins numbered:
13-24-01 A Medical Assistance Bulletin entitled Doula Enrollment in the Medical Assistance Program
12/29/2023
Added Updated Pennsylvania Medicaid Managed Care Directory
12/28/2023
Added MA Bulletins numbered:
- 99-23-10 A Medical Assistance Bulletin entitled Payment for Services Associated with Qualifying Clinical Trials
12/27/2023
Added MA Bulletins numbered:
- 08-24-01 A Medical Assistance Bulletin entitled Interprofessional Consultation Services
Added Managed Care Enrollment Information:
- Added November 2023
12/21/2023
Added MA Bulletins numbered:
- 01-23-56 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, Incretin Mimetics/Enhancers – Pharmacy Services
12/20/2023
Added MA Bulletins numbered:
- 99-23-12 A Medical Assistance Bulletin entitled Ex Parte Retroactive Reinstatement of Coverage
- 99-23-11 A Medical Assistance Bulletin entitled Carr v. Becerra - Retroactive Reinstatement of Coverage
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
12/15/2023
Added Remittance Advice Dates - January 2024 Remittance Advice Date
12/13/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
12/12/2023
Added Managed Care Enrollment Information:
- Added October 2023
12/11/2023
Added MA Bulletins numbered:
- 01-23-27 A Medical Assistance Bulletin entitled MA Program Fee Schedule Updates for the Administration of SARS-CoV-2 Vaccines
12/08/2023
Added Updated Pennsylvania Medicaid Managed Care Directory
11/27/2023
Added MA Bulletins numbered:
- 01-23-47 A Medical Assistance Bulletin entitled Prior Authorization of Multiple Sclerosis Agents - Pharmacy Services
- 01-23-54 A Medical Assistance Bulletin entitled Prior Authorization of Ulcerative Colitis Agents - Pharmacy Services
11/16/2023
Added Remittance Advice Dates - December 2023 Remittance Advice Dates
11/14/2023
Added MA Bulletins numbered:
- 01-23-49 A Medical Assistance Bulletin entitled Prior Authorization of Obesity Treatment Agents - Pharmacy Services
- 01-23-52 A Medical Assistance Bulletin entitled Statewide Preferred Drug List (PDL) Updates - Pharmacy Services
11/13/2023
Added MA Bulletins numbered:
- 01-23-29 A Medical Assistance Bulletin entitled Prior Authorization of Antibiotics, GI and Related Agents - Pharmacy Services
- 01-23-32 A Medical Assistance Bulletin entitled Prior Authorization of Antipsychotics - Pharmacy Services
- 01-23-35 A Medical Assistance Bulletin entitled Prior Authorization of Bone Density Regulators - Pharmacy Services
- 01-23-39 A Medical Assistance Bulletin entitled Prior Authorization of Estrogens - Pharmacy Services
- 01-23-42 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, Incretin Mimetics/Enhancers - Pharmacy Services
Added Updated Pennsylvania Medicaid Managed Care Directory
11/09/2023
Added MA Bulletins numbered:
- 01-23-46 A Medical Assistance Bulletin entitled Prior Authorization of Migraine Prevention Agents – Pharmacy Services
- 01-23-48 A Medical Assistance Bulletin entitled Prior Authorization of Natalizumab [formerly Tysabri (natalizumab)] – Pharmacy Services
- 01-23-50 A Medical Assistance Bulletin entitled Prior Authorization of Pituitary Suppressive Agents, LHRH – Pharmacy Services
- 01-23-51 A Medical Assistance Bulletin entitled Prior Authorization of Sedative Hypnotics – Pharmacy Services
- 01-23-53 A Medical Assistance Bulletin entitled Prior Authorization of Tubeless Insulin Delivery Devices – Pharmacy Services
11/08/2023
Added MA Bulletins numbered:
- 01-23-30 A Medical Assistance Bulletin entitled Prior Authorization of Antidepressants, Other - Pharmacy Services
- 01-23-34 A Medical Assistance Bulletin entitled Prior Authorization of Anxiolytics - Pharmacy Services
- 01-23-43 A Medical Assistance Bulletin entitled Prior Authorization of Immunomodulators, Atopic Dermatitis – Pharmacy Services
- 01-23-44 A Medical Assistance Bulletin entitled Prior Authorization of Lipotropics, Other - Pharmacy Services
- 01-23-45 A Medical Assistance Bulletin entitled Prior Authorization of Macular Degeneration Agents - Pharmacy Services
11/07/2023
Added MA Bulletins numbered:
- 01-23-28 A Medical Assistance Bulletin entitled Prior Authorization of Androgenic Agents - Pharmacy Services
- 01-23-31 A Medical Assistance Bulletin entitled Prior Authorization of Antihemophilia Agents - Pharmacy Services
- 01-23-38 A Medical Assistance Bulletin entitled Prior Authorization of Dupixent (dupilumab) - Pharmacy Services
- 01-23-40 A Medical Assistance Bulletin entitled Prior Authorization of Hereditary Angioedema (HAE) Agents - Pharmacy Services
- 01-23-41 A Medical Assistance Bulletin entitled Prior Authorization of Hepatitis C Agents - Pharmacy Services
Added the updated Pennsylvania Medicaid Managed Care Directory
11/06/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Added MA Bulletins numbered:
- 01-23-33 A Medical Assistance Bulletin entitled Prior Authorization of Antivirals, CMV - Pharmacy Services
- 01-23-36 A Medical Assistance Bulletin entitled Prior Authorization of Continuous Glucose Monitoring Products - Pharmacy Services
- 01-23-37 A Medical Assistance Bulletin entitled Prior Authorization of Cytokine and CAM Antagonists - Pharmacy Services
11/03/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
11/02/2023
Added MA Bulletins numbered:
- 24-23-23 A Medical Assistance Bulletin entitled Addition of a Procedure Code for Sexually Transmitted Infection Test Kits
10/30/2023
Added Managed Care Enrollment Information:
- Added September 2023
10/23/2023
Added MA Bulletins numbered:
- 01-23-24 A Medical Assistance Bulletin entitled 2023 Medical Assistance Program Dental Fee Schedule Update and Dental Provider Handbook Update
10/17/2023
Added Remittance Advice Dates - November 2023 Remittance Advice Dates
10/11/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
10/05/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
- New Quick Tip for Group and Individual Providers
- Revisions to Participating Drug Company List for Medicaid Drug Rebate Program
10/03/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #270 - Revalidation of Multiple Locations
10/02/2023
Added Managed Care Enrollment Information:
- Added August 2023
09/29/2023
Added MA Bulletins numbered:
- 01-23-25 A Medical Assistance Bulletin entitled Addition of Procedure Codes for Vaccine Administration
- 01-23-26 A Medical Assistance Bulletin entitled Street Medicine
09/28/2023
Added MA Bulletin numbered:
- 27-23-15 A Medical Assistance Bulletin entitled 2023 Pediatric Dental Periodicity Schedule Updates
09/20/2023
Added MA Bulletin numbered:
- 05-23-08 A Medical Assistance Bulletin entitled Update to Electronic Visit Verification Requirements for Pediatric Home Health Aide Services in the Fee-or-Service and Managed Care Delivery Systems
09/18/2023
Added Remittance Advice Dates - October 2023 Remittance Advice Dates
09/13/2023
Added MA Bulletin numbered:
- 01-23-23 A Medical Assistance Bulletin entitled 2023 Updates to Childhood Nutrition and Weight Management Services
09/11/2023
Added MA Bulletin numbered:
- 05-23-06 A Medical Assistance Bulletin entitled Pediatric Shift Care Services for Beneficiaries Under 21 Years of Age
09/08/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #269 - Incontinence Products Billing Reminder
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
09/06/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #207 - MA Program Fee Schedule Updates for Act 62 Procedure Codes
09/01/2023
Added MA Bulletin numbered:
- 01-23-22 A Medical Assistance Bulletin entitled Updates to the Family Planning Services Program Fee Schedule
08/31/2023
Added MA Bulletin numbered:
- 99-23-09 A Medical Assistance Bulletin entitled 2023 Healthcare Common Procedure Coding System (HCPCS) Updates, Fee Adjustments, and Other Procedure Code Changes
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #268 - Reminder for Prescribers and Providers to Request Prior Authorization for Processing Codes L1851 and L1852
08/28/2023
Added the updated Pennsylvania Medicaid Managed Care Directory
08/22/2023
Added Remittance Advice Dates - September 2023 Remittance Advice Dates
08/17/2023
Added Managed Care Enrollment Information:
- Added July 2023
08/07/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #263 - 180 Day Exception Electronic Process - Updated 08/01/2023
08/02/2023
Added MA Bulletin numbered:
- 99-23-08 A Medical Assistance Bulletin entitled Updates to Guidelines for the Delivery of Physical Health Services via Telehealth
07/31/2023
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #85 - Department of Human Services (DHS) Breast & Cervical Cancer Prevention & Treatment (BCCPT) Program Updated July 2023
07/26/2023
Added MA Bulletin numbered:
- 01-23-21 A Medical Assistance Bulletin entitled Updated Sterilization Consent Form (MA 31)
07/21/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #263 - 180 Day Exception Electronic Process - Updated 07/21/2023
07/20/2023
Added Managed Care Enrollment Information:
- Added June 2023
07/17/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #263 - 180 Day Electronic Process - Updated 07/14/2023
07/14/2023
Added Remittance Advice Dates - August 2023 Remittance Advice Dates
07/05/2023
Added MA Bulletin numbered:
- 08-23-12 A Medical Assistance Bulletin entitled Street Medicine
07/03/2023
Added Provider Quick Tips - The following Quick Tip has been added to the website.
- Added #267 - Delayed Implementation of All Patient Refined-Diagnosis Related Group (APR DRG) Version 38 & 39
06/30/2023
Added MA Bulletin numbered:
- 01-23-14 A Medical Assistance Bulletin entitled Clinical Prior Authorization of Non-PDL Drugs – Pharmacy Services
- 01-23-18 A Medical Assistance Bulletin entitled Prior Authorization of Opioid Use Disorder Treatments - Pharmacy Services
- 01-23-19 A Medical Assistance Bulletin entitled Prior Authorization of Progestational Agents - Pharmacy Services
- 01-23-20 A Medical Assistance Bulletin entitled Prior Authorization of Tepezza (teprotumumab-trbw) - Pharmacy Services
Added the updated Pennsylvania Medicaid Managed Care Directory
06/29/2023
Added MA Bulletin numbered:
- 01-23-17 A Medical Assistance Bulletin entitled Prior Authorization of Hepatitis C Agents - Pharmacy Services
- 01-23-16 A Medical Assistance Bulletin entitled Prior Authorization of Cough and Cold Medications - Pharmacy Services
- 01-23-15 A Medical Assistance Bulletin entitled Prior Authorization of Compounded Prescriptions - Pharmacy Services
- 01-23-13 A Medical Assistance Bulletin entitled Prior Authorization of Antiparasitics, Topical - Pharmacy Services
- 01-23-12 A Medical Assistance Bulletin entitled Prior Authorization of Antiemetic/Antivertigo Agents - Pharmacy Services
06/28/2023
Added MA Bulletin numbered:
- 01-23-09 A Medical Assistance Bulletin entitled Prior Authorization of Amyloid-Targeted Monoclonal Antibodies (MABs) - Pharmacy Services
- 01-23-10 A Medical Assistance Bulletin entitled Prior Authorization of Analgesics, Opioid Long-Acting - Pharmacy Services
- 01-23-11 A Medical Assistance Bulletin entitled Prior Authorization of Analgesics, Opioid Short-Acting - Pharmacy Services
06/27/2023
Added MA Bulletin numbered:
- 99-23-07 A Medical Assistance Bulletin entitled Pennsylvania’s Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
Added Managed Care Enrollment Information:
- Added April 2023 and May 2023
06/22/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
- APR DRG v38 & 39 Update
- Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
06/21/2023
Added Remittance Advice Dates - July 2023 Remittance Advice Dates
06/20/2023
Added MA Bulletin numbered:
- 01-23-08 A Medical Assistance Bulletin entitled MA Program Fee Schedule Update for an Additional Bivalent Dose of the SARS-CoV-2 Vaccine Manufactured by Pfizer, Inc.
06/16/2023
Added MA Bulletin numbered:
- 99-23-05 A Medical Assistance Bulletin entitled Updates for the Enrollment or Revalidation of Co-Located Providers
06/01/2023
Updated Provider Quick Tips - The following Quick Tips have been updated to the website.
- Updated #254 - Payment Error Rate Measurement (PERM) Initiative for RY 2025
Added MA Bulletin numbered:
- 99-23-06 A Medical Assistance Bulletin entitled 2023 Evaluation and Management Fee Adjustments and Code Updates
05/30/2023
Added MA Bulletin numbered:
- 01-23-05 A Medical Assistance Bulletin entitled End-Dating COVID-19 Pharmacy Specimen Collection and Laboratory Testing Procedure Codes
- 01-23-06 A Medical Assistance Bulletin entitled Billing Updates for Vaccine Counseling Only Visits for Beneficiaries Under the Age of 21
- 01-23-07 A Medical Assistance Bulletin entitled Billing Updates for COVID-19 Vaccine Counseling Only Visits for Beneficiaries Under the Age of 21
05/16/2023
Added Remittance Advice Dates - June 2023 Remittance Advice Dates
05/12/2023
Updated Provider Quick Tips - The following Quick Tips have been updated to the website.
05/09/2023
Updated Provider Quick Tips - The following Quick Tips have been updated to the website.
- Updated #233 - Waiver of Prudent Pay During COVID-19 Emergency
05/08/2023
Added the updated Pennsylvania Medicaid Managed Care Directory
05/01/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #263 - 180 Day Electronic Process - Updated 05/01/2023
04/27/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #263 - 180 Day Electronic Process - Updated 04/27/2023
04/24/2023
Added Managed Care Enrollment Information:
- Added March 2023
04/17/2023
Added Remittance Advice Dates - May 2023 Remittance Advice Dates
04/13/2023
Added MA Bulletin numbered:
- 01-23-04 A Medical Assistance Bulletin entitled Additional Bivalent SARS-CoV-2 Vaccine Doses Manufactured by Moderna, Inc. and Pfizer, Inc.
99-23-02 A Medical Assistance Bulletin entitled Updates to the Emergency Medical Condition Information Eligibility Form (PA 1917)
04/12/2023
Added MA Bulletin numbered:
- 99-23-03 A Medical Assistance Bulletin entitled 2023 Recommended Child and Adolescent Immunization Schedule
Added Provider Quick Tips - The following Quick Tips have been added to the website.
04/04/2023
Added MA Bulletin numbered:
- 17-23-01 A Medical Assistance Bulletin entitled Implementation of ADA Claim Form – Version 2019
04/03/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #263 - 180 Day Electronic Process - Updated 3/30/2023
03/28/2023
Added MA Bulletin numbered:
- 99-23-01 A Medical Assistance Bulletin entitled Medical Assistance Program Fee Schedule Revisions
03/24/2023
Added MA Bulletin numbered:
- 01-23-03 A Medical Assistance Bulletin entitled Administration of Booster Dose of SARS-CoV-2 Vaccine Manufactured by Novavax
03/22/2023
Added Managed Care Enrollment Information:
- Added February 2023
03/21/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
03/17/2023
Added Remittance Advice Dates - April 2023 Remittance Advice Dates
03/08/2023
Updated Provider Quick Tips - The following Quick Tips have been added to the website.
03/03/2023
Added the updated Pennsylvania Medicaid Managed Care Directory
03/02/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
02/22/2023
Added Managed Care Enrollment Information:
- Added January 2023
02/17/2023
Added MA Bulletin numbered:
- 05-23-02 A Medical Assistance Bulletin entitled Coverage of Case Specific Training/Shadow Nursing for Private Duty/Shift Nursing Services for MA Beneficiaries Under 21 Years of Age
Added Remittance Advice Dates - March 2023 Remittance Advice Dates
02/08/2023
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #266 - New Group Provider Access for Reactivation/Revalidation Changes of Group Members (Fee Assigned Practitioners)
02/03/2023
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #266 - New Group Provider Access for Reactivation/Revalidation Changes of Group Members (Fee Assigned Practitioners)
01/31/2023
Added Provider Quick Tip - The following Quick Tip has been added to the website.
01/26/2023
Added MA Bulletin numbered:
- 26-23-02 A Medical Assistance Bulletin entitled 2023 Ambulance Fee Increases
01/23/2023
Added Managed Care Enrollment Information:
- Added December 2022
01/20/2023
Added MA Bulletin numbered:
- 01-23-01 A Medical Assistance Bulletin entitled Addition of Bivalent Booster Dose of the SARS-CoV-2 Vaccines Manufactured by Pfizer, Inc. and Moderna, Inc.
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #263 - 180 Day Electronic Process - updated 1/20/23
01/19/2023
Added MA Bulletin numbered:
- 01-23-02 A Medical Assistance Bulletin entitled Rescind 340B Drug Pricing Program - Dispensing 340B Purchased Drugs
01/17/2023
Added the updated Pennsylvania Medicaid Managed Care Directory
Added Remittance Advice Dates - February 2023 Remittance Advice Dates
01/04/2023
Added Managed Care Enrollment Information:
- Added November 2022
12/30/2022
Added Provider Quick Tips - The following Quick Tips have been added to the website.
12/29/2022
Added MA Bulletin numbered:
- 99-22-11 A Medical Assistance Bulletin entitled Reinstatement of Provider Enrollment Requirements
12/23/2022
Added the updated Pennsylvania Medicaid Managed Care Directory
12/22/2022
Added MA Bulletin numbered:
- 01-22-78 A Medical Assistance Bulletin entitled 340B Drug Pricing Program - Dispensing 340B Purchased Drugs
12/19/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
12/16/2022
Added Remittance Advice Dates - January 2023 Remittance Advice Dates
12/13/2022
Added MA Bulletin numbered:
- 01-22-63 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, Incretin Mimetics/Enhancers – Pharmacy Services
- 05-22-14 A Medical Assistance Bulletin entitled Disposable Breast Milk Collection and Storage Bags and Breast Pump
12/09/2022
Added MA Bulletin numbered:
- 01-22-50 A Medical Assistance Bulletin entitled Prior Authorization of Monoclonal Antibodies - Anti-IL, Anti-IgE, Anti-TSLP (Formerly Monoclonal Antibodies - Anti-IL, Anti-IgE) - Pharmacy Services
- 01-22-75 A Medical Assistance Bulletin entitled Statewide Preferred Drug List (PDL) Updates - Pharmacy Services
- 01-22-70 A Medical Assistance Bulletin entitled Coverage and Prior Authorization of Obesity Treatment Agents - Pharmacy Services
12/08/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated - #256 - Procedure Code/Modifier Combinations to be Utilized When Requesting Home Accessibility Durable Medical Equipment (DME) and DME Repairs in the Fee-for-Service Delivery System (revised December 2022)
Added MA Bulletin numbered:
- 01-22-73 A Medical Assistance Bulletin entitled Prior Authorization of Platelet Aggregation Inhibitors - Pharmacy Services
- 01-22-65 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, SGLT2 Inhibitors - Pharmacy Services
- 01-22-72 A Medical Assistance Bulletin entitled Prior Authorization of Pituitary Suppressive Agents, LHRH - Pharmacy Services
- 01-22-71 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Anti-Inflammatories - Pharmacy Services
12/07/2022
Added MA Bulletin numbered:
- 01-22-68 A Medical Assistance Bulletin entitled Prior Authorization of Lipotropics, Other - Pharmacy Services
- 01-22-74 A Medical Assistance Bulletin entitled Prior Authorization of Stimulants and Related Agents - Pharmacy Services
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated - #264 – Electronic Visit Verification
Added Managed Care Enrollment Information:
- Added September 2022 and October2022
12/02/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
11/10/2022
Added MA Bulletin numbered:
- 26-22-07 A Medical Assistance Bulletin entitled 2023 Ambulance Fee Increases
- 24-22-32 A Medical Assistance Bulletin entitled At-Home Over-The-Counter COVID-19 Tests
- 01-22-57 A Medical Assistance Bulletin entitled Prior Authorization of Dry Eye Treatments (Formerly Ophthalmics, Immunomodulators) - Pharmacy Services
- 01-22-64 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, Insulin and Related Agents - Pharmacy Services
- 01-22-66 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, TZDs - Pharmacy Services
- 01-22-67 A Medical Assistance Bulletin entitled Prior Authorization of Immunomodulators, Atopic Dermatitis - Pharmacy Services
- 01-22-69 A Medical Assistance Bulletin entitled Prior Authorization of NSAIDs - Pharmacy Services
11/09/2022
Added MA Bulletin numbered:
- 01-22-60 A Medical Assistance Bulletin entitled Prior Authorization of Glucocorticoids, Inhaled - Pharmacy Services
- 01-22-61 A Medical Assistance Bulletin entitled Prior Authorization of Glucocorticoids, Oral - Pharmacy Services
- 01-22-62 A Medical Assistance Bulletin entitled Prior Authorization of Hepatitis C Agents - Pharmacy Services
- 01-22-49 A Medical Assistance Bulletin entitled Prior Authorization of Antihemophilia Agents - Pharmacy Services
- 01-22-45 A Medical Assistance Bulletin entitled Prior Authorization of Angiotensin Modulator Combinations - Pharmacy Services
- 01-22-54 A Medical Assistance Bulletin entitled Prior Authorization of Bile Salts - Pharmacy Services
- 01-22-56 A Medical Assistance Bulletin entitled Prior Authorization of Cytokine and CAM Antagonists - Pharmacy Services
11/08/2022
Added MA Bulletin numbered:
- 01-22-47 A Medical Assistance Bulletin entitled Prior Authorization of Antibiotics, GI and Related Agents - Pharmacy Services
- 01-22-48 A Medical Assistance Bulletin entitled Prior Authorization of Antifibrotic Respiratory Agents (Formerly Idiopathic Pulmonary Fibrosis (IPF) Agents) - Pharmacy Services
- 01-22-52 A Medical Assistance Bulletin entitled Prior Authorization of Antipsychotics - Pharmacy Services
- 01-22-53 A Medical Assistance Bulletin entitled Prior Authorization of Antivirals, CMV - Pharmacy Services
- 01-22-55 A Medical Assistance Bulletin entitled Prior Authorization of Corticotropin (formerly H.P. Acthar Gel) - Pharmacy Services
- 01-22-58 A Medical Assistance Bulletin entitled Prior Authorization of Dupixent (dupilumab) - Pharmacy Services
- 01-22-59 A Medical Assistance Bulletin entitled Prior Authorization of GI Motility, Chronic Agents - Pharmacy Services
11/04/2022
Added the updated Pennsylvania Medicaid Managed Care Directory
Added MA Bulletin numbered:
- 01-22-43 A Medical Assistance Bulletin entitled Prior Authorization of Acne Agents, Oral - Pharmacy Services
- 01-22-44 A Medical Assistance Bulletin entitled Prior Authorization of Alcohol Use Disorder Agents – Pharmacy Services
- 01-22-46 A Medical Assistance Bulletin entitled Prior Authorization of Antianginal Agents - Pharmacy Services
- 01-22-51 A Medical Assistance Bulletin entitled Prior Authorization of Antipsoriatics, Topical - Pharmacy Services
- 99-22-10 A Medical Assistance Bulletin entitled Enrollment of Providers for Medicare Cost-Sharing Only
11/03/2022
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on December 7th, 2022 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on December 8th, 2022 at 10:00AM EDT - Register here.
11/02/2022
Added Remittance Advice Dates - December 2022 Remittance Advice Dates
10/17/2022
Added MA Bulletin numbered:
- 01-22-18 Medical Assistance Bulletin entitled - SARS-CoV-2 Vaccine Booster Manufactured by Moderna, Inc.
Added Remittance Advice Dates - November 2022 Remittance Advice Dates
10/07/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #263 - 180 Day Electronic Process
Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on October 13, 2022 at 10:00AM EDT - Register here.
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on October 26, 2022 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on October 27, 2022 at 10:00AM EDT - Register here.
09/29/2022
Added Managed Care Enrollment Information:
- Added August 2022
09/28/2022
Added MA Bulletin numbered:
- 01-22-39 Medical Assistance Bulletin entitled - Updates to Pediatric SARS-CoV-2 Vaccines Manufactured by Pfizer, Inc. and Moderna, Inc.
09/26/2022
Added MA Bulletin numbered:
- 05-22-08 Medical Assistance Bulletin entitled - Additions to the Medical Assistance Fee Schedule for Private Duty Nursing Services Provided to Beneficiaries Under the Age of 21.
09/23/2022
Added MA Bulletin numbered:
- 01-22-12 Medical Assistance Bulletin entitled - COVID-19 Vaccine Counseling Only Visits for Beneficiaries Under 21
09/22/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #260 - Provider Electronic Portal Update
09/20/2022
Added MA Bulletin numbered:
- 01-22-14 Medical Assistance Bulletin entitled - Vaccine Counseling Only Visits for Beneficiaries Under 21
09/19/2022
Added MA Bulletin numbered:
- 01-22-38 Medical Assistance Bulletin entitled - Administration of SARS-CoV-2 Vaccine Manufactured by Novavax
- 99-22-07 Medical Assistance Bulletin entitled - Pennsylvania’s Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
Added the updated Pennsylvania Medicaid Managed Care Directory
09/16/2022
Added Remittance Advice Dates - October 2022 Remittance Advice Dates
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
09/15/2022
Added MA Bulletin numbered:
- 35-22-02 Medical Assistance Bulletin entitled - School-Based ACCESS Program Provider Handbook
09/14/2022
Added MA Bulletin numbered:
- 01-22-42 Medical Assistance Bulletin entitled - Adult Vaccine Procedure Code Updates and Additions
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
09/13/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #262 - Provider Enrollment Summary Enhancements
09/12/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
09/09/2022
Added the updated Pennsylvania Medicaid Managed Care Directory
09/07/2022
Added MA Bulletin numbered:
- 27-22-27 Medical Assistance Bulletin entitled - 2022 Medical Assistance Program Dental Fee Schedule Update
09/06/2022
Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on September 8, 2022 at 10:00AM EDT - Register here.
09/02/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
- Corrections to Cycle 07 & 66 Credits (Accounts Receivables) recoupments
- Community Support Service Providers - Federal Financial Participation Rate Change and Continued Billing Requirements
- Provider Enrollment Summary Enhancements
09/01/2022
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on September 21, 2022 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on September 22, 2022 at 10:00AM EDT - Register here.
Added Managed Care Enrollment Information:
- Added July 2022
08/29/2022
Added MA Bulletin numbered:
- 08-22-19 Medical Assistance Bulletin entitled - Naloxone Distribution by Federally Qualified Health Centers and Rural Health Clinics
- 01-22-41 Medical Assistance Bulletin entitled - Additions to the Medical Assistance Fee Schedule for Monkeypox Laboratory Testing and Vaccines
08/26/2022
Added MA Bulletin numbered:
- 08-22-44 Medical Assistance Bulletin entitled - Addition of Behavioral Health Providers to Certain Procedure Codesand other Procedure Code Changes
- 99-22-05 Medical Assistance Bulletin entitled - 2022 Healthcare Common Procedure Coding System (HCPCS) Updates and Other Procedure Code Changes
- 01-22-15 Medical Assistance Bulletin entitled - Adult Vaccine Procedure Code Updates and Additions - OBSOLETE
08/19/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
08/16/2022
Added Remittance Advice Dates - September 2022 Remittance Advice Dates
Added Remittance Advice Alert - The following Remittance Advice Alert/PROMISe™ Banner page has been added to the website.
08/10/2022
Added MA Bulletin numbered:
- 05-22-09 Medical Assistance Bulletin entitled - Electronic Visit Verification Requirements for Home Health Care Services in the Fee-for-Service Delivery and Managed Care Delivery Systems
08/01/2022
Added Managed Care Enrollment Information:
07/29/2022
Added Managed Care Enrollment Information:
- Added April 2022
07/26/2022
Added Remittance Advice Dates - August 2022 Remittance Advice Dates
07/14/2022
Added MA Bulletin numbered:
- 01-22-26 Medical Assistance Bulletin entitled - Prior Authorization of Epinephrine, Self-Injected - Pharmacy Services
- 01-22-28 Medical Assistance Bulletin entitled - Prior Authorization of Hypoglycemics, Alpha Glucosidase Inhibitors - Pharmacy Services
- 01-22-29 Medical Assistance Bulletin entitled - Prior Authorization of Hypoglycemics, Metformins - Pharmacy Services
07/13/2022
Added MA Bulletin numbered:
- 01-22-24 Medical Assistance Bulletin entitled - Prior Authorization of Contraceptives, Oral - Pharmacy Services
- 01-22-25 Medical Assistance Bulletin entitled - Prior Authorization of Contraceptives, Other - Pharmacy Services
- 01-22-19 Medical Assistance Bulletin entitled - Prior Authorization of Acne Agents, Topical - Pharmacy Services
- 01-22-27 Medical Assistance Bulletin entitled - Prior Authorization of Hepatitis B Agents - Pharmacy Services
07/11/2022
Added MA Bulletin numbered:
- 01-22-23 Medical Assistance Bulletin entitled - Prior Authorization of Antipsoriatics, Oral - Pharmacy Services
- 01-22-22 Medical Assistance Bulletin entitled - Prior Authorization of Antiparkinson’s Agents - Pharmacy Services
- 01-22-21 Medical Assistance Bulletin entitled - Prior Authorization of Antihypertensives, Sympatholytic - Pharmacy Services
- 01-22-20 Medical Assistance Bulletin entitled - Prior Authorization of Antibiotics, Topical - Pharmacy Services
07/08/2022
Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on July 14, 2022 at 10:00AM EDT - Register here.
Added MA Bulletin numbered:
- 01-22-31 Medical Assistance Bulletin entitled - Prior Authorization of Immunomodulators, Topical – Pharmacy Services
- 01-22-30 Medical Assistance Bulletin entitled - Prior Authorization of Hypoglycemics, Sulfonylureas – Pharmacy Services
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on July 27, 2022 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on July 28, 2022 at 10:00AM EDT - Register here.
07/07/2022
Added MA Bulletin numbered:
- 01-22-33 Medical Assistance Bulletin entitled - Prior Authorization of Lipotropics, Statins – Pharmacy Services.
- 01-22-32 Medical Assistance Bulletin entitled - Prior Authorization of Leukotriene Modifiers – Pharmacy Services.
07/06/2022
Added MA Bulletin numbered:
- 09-22-37 Medical Assistance Bulletin entitled - Disposable Surgical Masks.
- 01-22-35 Medical Assistance Bulletin entitled - Prior Authorization of Phosphate Binders - Pharmacy Services.
- 01-22-34 Medical Assistance Bulletin entitled - Prior Authorization of Methotrexate – Pharmacy Services.
07/05/2022
Added MA Bulletin numbered:
- 01-22-37 Medical Assistance Bulletin entitled - Prior Authorization of Thyroid Hormones - Pharmacy Services.
- 01-22-36 Medical Assistance Bulletin entitled - Prior Authorization of Smoking Cessation Products– Pharmacy Services.
07/01/2022
Added MA Bulletin numbered:
- 05-22-02 Medical Assistance Bulletin entitled - Reinstatement of Prior Authorization Requirements for Shift Care Services for Beneficiaries Under 21 Years of Age
06/30/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #85 - Department of Human Services (DHS) Breast & Cervical Cancer Prevention & Treatment (BCCPT) Program Updated July 2022
06/21/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
06/17/2022
Added Remittance Advice Dates - July 2022 Remittance Advice Dates
06/13/2022
Added MA Bulletin numbered:
- 08-22-13 Medical Assistance Bulletin entitled - Teledentistry Guidelines and Dental Fee Schedule Updates
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on June 22, 2022 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on June 23, 2022 at 10:00AM EDT - Register here.
06/10/2022
Added MA Bulletin numbered:
- 08-20-68 Medical Assistance Bulletin entitled - Federally Qualified Health Center and Rural Health Clinic Payment for SARS-CoV-2 Vaccine Administration
06/08/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
06/06/2022
Added MA Bulletin numbered:
- 01-22-13 Medical Assistance Bulletin entitled - Updates to Blood Lead Reference Value and Environmental Lead Investigation (ELI) Provider Qualifications Requirements
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #260 - Provider Electronic Portal Update
06/03/2022
Added MA Bulletin numbered:
- 01-22-16 A Medical Assistance Bulletin entitled - Third Dose of Pediatric SARS-CoV-2 Vaccine Manufactured by Pfizer, Inc.
- 01-22-17 A Medical Assistance Bulletin entitled - Addition to Medical Assistance Program Fee Schedule for Administration of Ready-to-Use SARS-CoV-2 Vaccine Manufactured by Pfizer, Inc.
06/02/2022
Added Managed Care Delivery System Subcommittee agenda and draft file note - The June 2022 Managed Care Delivery System Subcommittee agenda and May 2022 draft file note have been posted and can be accessed from the Meeting Minutes archives page.
Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on June 9, 2022 at 10:00AM EDT - Register here.
05/19/2022
Added Remittance Advice Dates - June 2022 Remittance Advice Dates
05/12/2022
Added MA Bulletin numbered:
- 99-22-03 A Medical Assistance Bulletin entitled - 2022 Recommended Child and Adolescent Immunization Schedule
05/10/2022
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on May 25, 2022 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on May 26, 2022 at 10:00AM EDT - Register here.
05/09/2022
Added MA Bulletin numbered:
- 01-22-11 A Medical Assistance Bulletin entitled - Addition of Monoclonal Antibody Product Bebtelovimab to the MA Program Fee Schedule
05/06/2022
Added MA Bulletin numbered:
- 99-22-02 A Medical Assistance Bulletin entitled - Updates to Guidelines for the Delivery of Physical Health Services via Telemedicine
Added Managed Care Delivery System Subcommittee agenda and draft file note - The May 2022 Managed Care Delivery System Subcommittee agenda and April 2022 draft file note have been posted and can be accessed from the Meeting Minutes archives page.
Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on May 12, 2022 at 10:00AM EDT - Register here.
05/02/2022
Added MA Bulletin numbered:
- 35-22-01 A Medical Assistance Bulletin entitled - School-Based ACCESS Program Provider Handbook Mid-Year Update
04/28/2022
Added the updated Pennsylvania Medicaid Managed Care Directory
04/26/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
04/21/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Added Managed Care Enrollment Information:
- Added March 2022
04/19/2022
Added Remittance Advice Dates - May 2022 Remittance Advice Dates
04/18/2022
Added MA Bulletin numbered:
- 05-22-01 A Medical Assistance Bulletin entitled - Additions to the Medical Assistance Fee Schedule for Personal Care Services Provided to Beneficiaries Under the Age of 21.
04/15/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
04/11/2022
Added Managed Care Delivery System Subcommittee agenda and draft file note - The April 2022 Managed Care Delivery System Subcommittee agenda and March 2022 draft file note have been posted and can be accessed from the Meeting Minutes archives page.
Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on April 14, 2022 at 10:00AM EDT - Register here.
04/07/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
04/06/2022
Added Managed Care Enrollment Information:
- Added January 2022
- Added February 2022
03/31/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on April 27, 2022 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on April 28, 2022 at 10:00AM EDT - Register here.
Added MA Bulletin numbered:
- 99-22-01 A Medical Assistance Bulletin entitled - Extension of Postpartum Coverage from 60 days to 12 Months
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #258 - Provider Electronic Solutions Software
03/30/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #257 - Medicare Sequestration Payment Reductions on All Claims Media Fee-for-Service (FFS) Claims Reinstated
03/25/2022
Added MA Bulletin numbered:
- 01-22-07 A Medical Assistance Bulletin entitled - Additions to the Medical Assistance Program Fee Schedule for Multiple Respiratory Pathogens Laboratory Tests
03/24/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
03/22/2022
Added MA Bulletin numbered:
- 01-22-09 A Medical Assistance Bulletin entitled - Prior Authorization of Anticonvulsants – Pharmacy Services
- 01-22-10 A Medical Assistance Bulletin entitled - Prior Authorization of Sedative Hypnotics – Pharmacy Services
03/21/2022
Added MA Bulletin numbered:
- 01-21-13 A Medical Assistance Bulletin entitled - MenQuadfi® and Vaxelis® Vaccines
03/17/2022
Added Remittance Advice Dates - April 2022 Remittance Advice Dates
03/11/2022
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on March 23, 2022 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on March 24, 2022 at 10:00AM EDT - Register here.
03/07/2022
Added MA Bulletin numbered:
- 01-21-60 A Medical Assistance Bulletin entitled - Update to Age Limits for Payment for Administration of the Flucelvax® Quadrivalent Vaccine
03/04/2022
Updated Provider Quick Tips - The following Quick Tips have been added to the website.
03/02/2022
Added the updated Pennsylvania Medicaid Managed Care Directory
02/28/2022
Updated Healthy Beginnings Plus - Current Provider List
02/24/2022
Added MA Bulletin numbered:
- 01-21-59 A Medical Assistance Bulletin entitled - SARs-CoV-2 Monoclonal Antibody Product Updates
- 08-20-66 A Medical Assistance Bulletin entitled - Federally Qualified Health Center and Rural Health Clinic Payment for SARS-CoV-2 Vaccine Administration
02/18/2022
Added Remittance Advice Dates - March 2022 Remittance Advice Dates
02/14/2022
Added MA Bulletin numbered:
- 01-22-02 A Medical Assistance Bulletin entitled - Community-Based Care Management Services Provided by Centers of Excellence for Opioid Use Disorders (COEs)
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on February 23, 2022 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on February 24, 2022 at 10:00AM EDT - Register here.
02/09/2022
Added MA Bulletin numbered:
- 01-22-08 A Medical Assistance Bulletin entitled - Preferred Specialty Pharmacy Drug Program Provider - Pharmacy Services
02/02/2022
Added Managed Care Enrollment Information:
- Added December 2021
02/01/2022
Added MA Bulletin numbered:
- 24-21-55 A Medical Assistance Bulletin entitled - At-Home Over-The-Counter COVID-19 Tests
Added Managed Care Enrollment Information:
- Added November 2021
01/28/2022
Added the updated Pennsylvania Medicaid Managed Care Directory
01/25/2022
Added MA Bulletin numbered:
- 01-22-06 A Medical Assistance Bulletin entitled - SARS-CoV-2 (COVID-19) Oral Antiviral Treatments with emergency use authorization (EUA) from the U.S. Food and Drug Administration (FDA)
01/24/2022
Added Managed Care Enrollment Information:
- Added October 2021
01/18/2022
Added Remittance Advice Dates - February 2022 Remittance Advice Dates
01/12/2022
Added MA Bulletin numbered:
- 01-22-03 A Medical Assistance Bulletin entitled - Prior Authorization of Aduhelm (aducanumab) - Pharmacy Services
01/11/2022
Added MA Bulletin numbered:
- 01-22-04 A Medical Assistance Bulletin entitled - Prior Authorization of Xyrem (sodium oxybate)/Xywav (calcium, magnesium, potassium, and sodium oxybates) - Pharmacy Services
01/07/2022
Added MA Bulletin numbered:
- 01-22-05 A Medical Assistance Bulletin entitled - Billing Procedure Update for Certified Registered Nurse Practitioners and Physicians Assistants
- Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on January 26, 2022 at 1:00PM EDT - Register here.
- Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on January 27, 2022 at 10:00AM EDT - Register here.
12/30/2021
Added MA Bulletin numbered:
- 01-21-19 A Medical Assistance Bulletin entitled - Vaccine Administration by Pharmacists - Pharmacy Services
12/28/2021
Added MA Bulletin numbered:
- 01-21-55 A Medical Assistance Bulletin entitled - Administration of a Booster Dose of the SARS-CoV-2 Vaccines
- 01-21-58 A Medical Assistance Bulletin entitled - Prior Authorization of HIV/AIDS Antiretrovirals - Pharmacy Services
12/27/2021
Added MA Bulletin numbered:
- 01-21-51 A Medical Assistance Bulletin entitled - Pediatric SARS-CoV-2 Vaccine Manufactured by Pfizer, Inc.
- 05-21-10 A Medical Assistance Bulletin entitled - Medical Assistance Program Fee Increases for Private Duty / Shift Nursing Services to MA Beneficiaries Under 21 Years of Age
12/21/2021
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
12/17/2021
Added Remittance Advice Dates - January 2022 Remittance Advice Dates
12/16/2021
Added MA Bulletin numbered:
- 01-21-56 A Medical Assistance Bulletin entitled - Prior Authorization of Anticonvulsants - Pharmacy Services
- 01-21-57 A Medical Assistance Bulletin entitled - Prior Authorization of Sedative Hypnotics - Pharmacy Services
12/01/2021
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on December 08, 2021 at 1:00PM EDT - Register here.
11/30/2021
Added MA Bulletin numbered:
- 27-21-02 A Medical Assistance Bulletin entitled - 2021 Medical Assistance Program Dental Fee Schedule Update
11/18/2021
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on December 9, 2021 at 10:00AM EDT - Register here.
Added Remittance Advice Dates - December 2021 Remittance Advice Dates
11/17/2021
Added MA Bulletin numbered:
- 01-21-52 A Medical Assistance Bulletin entitled - Prior Authorization of Growth Hormones - Pharmacy Services
- 01-21-53 A Medical Assistance Bulletin entitled - Prior Authorization of Immunosuppressives, Oral - Pharmacy Services
- 01-21-54 A Medical Assistance Bulletin entitled - Prior Authorization of Skeletal Muscle Relaxants - Pharmacy Services
11/16/2021
Added MA Bulletin numbered:
- 01-21-43 A Medical Assistance Bulletin entitled - Prior Authorization of VMAT2 Inhibitors - Pharmacy Services
- 01-21-44 A Medical Assistance Bulletin entitled - Prior Authorization of Zeposia (ozanimod) - Pharmacy Services
11/15/2021
Added MA Bulletin numbered:
- 01-21-38 A Medical Assistance Bulletin entitled - Prior Authorization of Pulmonary Hypertension Agents, Oral and Inhaled - Pharmacy Services
- 01-21-39 A Medical Assistance Bulletin entitled - Prior Authorization of Rilutek (riluzole) -Pharmacy Services-OBSOLETE
- 01-21-40 A Medical Assistance Bulletin entitled - Statewide Preferred Drug List (PDL) Implementation - Pharmacy Services
- 01-21-41 A Medical Assistance Bulletin entitled - Prior Authorization of Tysabri (natalizumab) - Pharmacy Services
- 01-21-42 A Medical Assistance Bulletin entitled - Prior Authorization of Ulcerative Colitis Agents - Pharmacy Services
Added MA Bulletin numbered:
- 01-21-31 A Medical Assistance Bulletin entitled - Prior Authorization of Lipotropics, Other - Pharmacy Services
- 01-21-32 A Medical Assistance Bulletin entitled - Prior Authorization of Monoclonal Antibodies (MABs) - Anti-IL Anti-IgE - Pharmacy Services
- 01-21-35 A Medical Assistance Bulletin entitled - Prior Authorization of Multiple Sclerosis Agents - Pharmacy Services
- 01-21-36 A Medical Assistance Bulletin entitled - Prior Authorization of Opioid Dependence Treatments - Pharmacy Services
- 01-21-37 A Medical Assistance Bulletin entitled - Prior Authorization of Pituitary Suppressive Agents, LHRH - Pharmacy Services
11/10/2021
Added MA Bulletin numbered:
- 01-21-30 A Medical Assistance Bulletin entitled - Prior Authorization of Immunomodulators, Atopic Dermatitis - Pharmacy Services
- 01-21-33 A Medical Assistance Bulletin entitled - Prior Authorization of Migraine Acute Treatment Agents - Pharmacy Services
- 01-21-34 A Medical Assistance Bulletin entitled - Prior Authorization of Migraine Prevention Agents - Pharmacy Services
- 01-21-47 A Medical Assistance Bulletin entitled - Prior Authorization of Glucocorticoids, Inhaled - Pharmacy Services
- 01-21-48 A Medical Assistance Bulletin entitled - Prior Authorization of Hepatitis C Agents - Pharmacy Services
Added the updated Pennsylvania Medicaid Managed Care Directory
11/08/2021
Added MA Bulletin numbered:
- 01-21-25 A Medical Assistance Bulletin entitled - Prior Authorization of Botulinum Toxins (Type A and Type B) - Pharmacy Services
- 01-21-27 A Medical Assistance Bulletin entitled - Prior Authorization of Chronic Obstructive Pulmonary Disease (COPD) Agents - Pharmacy Services
- 01-21-45 A Medical Assistance Bulletin entitled - Prior Authorization of Erythropoiesis Stimulating Agents (ESAs) - Pharmacy Services
- 01-21-46 A Medical Assistance Bulletin entitled - Prior Authorization of GI Motility, Chronic Agents - Pharmacy Services
- 01-21-49 A Medical Assistance Bulletin entitled - Prior Authorization of HIV/AIDS Antiretrovirals - Pharmacy Services
11/05/2021
Added MA Bulletin numbered:
- 01-21-23 A Medical Assistance Bulletin entitled - Prior Authorization of Bladder Relaxant Preparations - Pharmacy Services
- 01-21-24 A Medical Assistance Bulletin entitled - Prior Authorization of Bone Density Regulators - Pharmacy Services
- 01-21-26 A Medical Assistance Bulletin entitled - Prior Authorization of Bronchodilators, Beta Agonists - Pharmacy Services
- 01-21-28 A Medical Assistance Bulletin entitled - Prior Authorization of Cytokine and CAM Antagonists - Pharmacy Services
- 01-21-29 A Medical Assistance Bulletin entitled - Prior Authorization of Dupixent (dupilumab) - Pharmacy Services
11/04/2021
Added MA Bulletin numbered:
- 01-21-20 A Medical Assistance Bulletin entitled - Prior Authorization of Antiparasitics, Topical - Pharmacy Services
- 01-21-21 A Medical Assistance Bulletin entitled - Prior Authorization of Antipsychotics - Pharmacy Services
- 01-21-22 A Medical Assistance Bulletin entitled - Prior Authorization of Anxiolytics - Pharmacy Services
11/02/2021
Added MA Bulletin numbered:
- 01-21-14 A Medical Assistance Bulletin entitled - Prior Authorization of Alzheimer’s Agents - Pharmacy Services
- 01-21-15 A Medical Assistance Bulletin entitled - Prior Authorization of Antibiotics, GI and Related Agents - Pharmacy Services
- 01-21-16 A Medical Assistance Bulletin entitled - Prior Authorization of Antifungals, Topical - Pharmacy Services
- 01-21-17 A Medical Assistance Bulletin entitled - Prior Authorization of Antihemophilia Agents - Pharmacy Services
- 01-21-18 A Medical Assistance Bulletin entitled - Prior Authorization of Antihyperuricemics - Pharmacy Services
10/28/2021
Added Managed Care Enrollment Information:
- Added September 2021
10/22/2021
Added MA Bulletin numbered:
- 05-21-04 A Medical Assistance Bulletin entitled - Updated Error Status Code Descriptions for Personal Care Services Subject to Electronic Visit Verification
10/21/2021
Added MA Bulletin numbered:
- 08-21-07 A Medical Assistance Bulletin entitled - Naloxone Distribution by Federally Qualified Health Centers and Rural Health Clinics
10/19/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
10/18/2021
Added Remittance Advice Dates - November 2021 Remittance Advice Dates
10/15/2020
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #207 - MA Program Fee Schedule Updates for Act 62 Procedure Codes
10/13/2021
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on October 27, 2021 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on October 28, 2021 at 10:00AM EDT - Register here.
10/12/2021
Added Hospital Assessment Initiative - The following Potentially Avoidable Admissions pages have been added to the website.
- Hospital Quality Incentive Program Webinar
- Hospital Quality Incentive Program (HQIP) Measurement - Potentially Avoidable Admission (PAA)
10/07/2021
Added PROMISeTM Provider Handbooks and Billing Guides Information:
- Updated 837 Professional / CMS-1500 Claim Form
Updated CMS-1500 Billing Guide for PROMISeTM Healthy Beginnings Plus (HBP) Providers
10/04/2021
Added Managed Care Enrollment Information:
- Added August 2021
09/30/2021
Added MA Bulletin numbered
- 99-21-06 A Medical Assistance Bulletin entitled - Guidelines for the Delivery of Physical Health Services via Telemedicine
09/28/2021
Added Provider Quick Tips - The following Quick Tips have been added to the website.
09/24/2021
Added MA Bulletin numbered:
- 01-21-06 A Medical Assistance Bulletin entitled - Updates to the Family Planning Services Program Fee Schedule
09/23/2021
Added the updated Pennsylvania Medicaid Managed Care Directory
09/22/2021
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
09/21/2021
Added MA Bulletin numbered:
- 09-21-04 A Medical Assistance Bulletin entitled - Coverage of Home Accessibility Durable Medical Equipment and Procedure for obtaining an 1150 Administrative Waiver in the Fee-for-Service Delivery System
Added Provider Quick Tips - The following Quick Tips have been added to the website.
09/20/2021
Added Remittance Advice Dates - October 2021 Remittance Advice Dates
09/17/2021
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
09/10/2021
Added Managed Care Enrollment Information:
- Added July 2021
09/08/2021
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on September 22, 2021 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on September 23, 2021 at 10:00AM EDT - Register here.
09/03/2021
Added MA Bulletin numbered:
- 01-21-12 A Medical Assistance Bulletin entitled — Administration of a Third Dose of SARS-CoV-2 Vaccines Manufactured by Pfizer, Inc. and Moderna, Inc
08/20/2021
Added Remittance Advice Dates - September 2021 Remittance Advice Dates
Added MA Bulletin numbered:
- 99-21-04 A Medical Assistance Bulletin entitled 2021 Healthcare Common Procedure Coding System (HCPCS) Updates, Fee Adjustments and Other Procedure Code Changes.
07/30/2021
Added MA Bulletin numbered:
- 01-21-11 A Medical Assistance Bulletin entitled Corrected - Expansion of Providers for the Administration of SARS-CoV-2 Vaccines and Monoclonal Antibody Therapy
07/29/2021
Added MA Bulletin numbered:
- 01-21-04 A Medical Assistance Bulletin entitled SARS-CoV-2 Vaccine Administration for Beneficiaries who are Homebound
- 01-21-08 A Medical Assistance Bulletin entitled Expansion of Providers for the Administration of SARS-CoV-2 Vaccines and Monoclonal Antibody Therapy - OBSOLETE
07/27/2021
Added the updated Pennsylvania Medicaid Managed Care Directory
07/22/2021
Added Managed Care Enrollment Information:
- Added April 2021, May 2021 and June 2021
07/16/2021
Added Remittance Advice Dates - August 2021 Remittance Advice Dates
07/08/2021
Added MA Bulletin numbered:
- OMHSAS-21-06 A Medical Assistance Bulletin entitled Opioid Treatment Program Services for Dually Eligible Individuals
07/06/2021
Added MA Bulletin numbered:
- 24-21-05 A Medical Assistance Bulletin entitled Medical Assistance Program Fee Increase for Disposable Gloves
07/02/2021
Updated Provider Enrollment Documents:
- 11 - Mental Health/Substance Abuse Services Providers Mental Health/Substance Abuse Provider Requirements
- 21 - Case ManagerCase ManagerRequirements
06/30/2021
Added MA Bulletin numbered:
- 99-20-09 A Medical Assistance Bulletin entitled Medical Assistance (MA) Program Fee Schedule Revisions
06/29/2021
Added Provider Quick Tips - The following Quick Tips have been added to the website.
06/28/2021
Added MA Bulletin numbered:
- 99-21-05 A Medical Assistance Bulletin entitled 2021 Recommended Child and Adolescent Immunization Schedule
06/25/2021
Updated Provider Enrollment Documents:
- 11 - Mental Health/Substance Abuse Services Providers Mental Health/Substance Abuse Provider Requirements
- 21 - Case ManagerCase ManagerRequirements
06/24/2021
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Added MA Bulletin numbered:
- 99-21-02 A Medical Assistance Bulletin entitled Pennsylvania's Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
06/23/2021
Updated Provider Quick Tips - The following Quick Tips have been updated to the website.
- Updated #232 Billing Guidance for Alternative Screening Sites Related to COVID-19
- Updated #233 Waiver of Prudent Pay During COVID-19 Emergency
- Updated #237 Teledentistry Guidelines Related to COVID-19 for Dentists, Federally Qualified Health Centers and Rural Health Clinics
- Updated #242 Telemedicine Guidelines Related to COVID-19
- Updated #244 MA Eligibility During COVID-19 Emergency Disaster Declaration
- Updated #247 Nonemergency Ambulance Transportation Related to COVID-19
06/22/2021
Updated Healthy Beginnings Plus - Current Provider List
06/14/2021
Added Remittance Advice Dates - July 2021 Remittance Advice Dates
06/04/2021
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on June 23, 2021 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on June 24, 2021 at 10:00AM EDT - Register here.
05/20/2021
Updated Provider Enrollment Documents:
- 08 - Clinic FQHC Requirements / Additional Information
- 08 - Clinic RHC Requirements / Additional Information
- 09 - Certified Registered Nurse Practitioner (CRNP)CRNPRequirements
- 11 - Mental Health/Substance Abuse Services Providers Mental Health/Substance Abuse Provider Requirements
- 17 - TherapistTherapistRequirements
- 19 - PsychologistPsychologist Requirements
- 21 - Case ManagerCase ManagerRequirements
- 31 - Physician/Physician GroupPhysician Requirements
05/18/2021
Added MA Bulletin numbered:
- 01-20-10 A Medical Assistance Bulletin entitled Addition of COVID-19 Antigen Laboratory Test Codes to the MA Program Fee Schedule
Added Remittance Advice Dates - June 2021 Remittance Advice Dates
Added the updated Pennsylvania Medicaid Managed Care Directory
04/30/2021
Added MA Bulletin numbered:
- 99-21-03 A Medical Assistance Bulletin entitled Reinstatement of Prior Authorization Requirements for Certain Services
04/27/2021
Added Provider Quick Tips - The following Quick Tips have been added to the website.
04/19/2021
Added MA Bulletin numbered:
- 01-21-03 A Medical Assistance Bulletin entitled Fee Increase for the Administration of SARS-CoV-2 Vaccines
04/16/2021
Added Remittance Advice Dates - May 2021 Remittance Advice Dates
04/15/2021
Added MA Bulletin numbered:
- 08-21-01 A Medical Assistance Bulletin entitled Dental Benefit Limit Exception Process Update
04/14/2021
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on April 21, 2021 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on April 22, 2021 at 10:00AM EDT - Register here.
03/25/2021
Added MA Bulletin numbered:
- 01-20-61 A Medical Assistance Bulletin Addition to Medical Assistance Program Fee Schedule for Administration of SARS-CoV-2 Monoclonal Antibody Therapy
03/23/2021
Added MA Bulletin numbered:
- 99-21-01 A Medical Assistance Bulletin Restoration of Provider Revalidation Requirements
03/22/2021
Added MA Bulletin numbered:
- 01-21-02 A Medical Assistance Bulletin Updates to the Medical Assistance Program Fee Schedule for Administration of SAR-CoV-2 Monoclonal Antibody Therapy
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
03/18/2021
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on March 24, 2021 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on March 25, 2021 at 10:00AM EDT - Register here.
Added Managed Care Enrollment Information:
- Added February 2021
03/15/2021
Added Remittance Advice Dates - April 2021 Remittance Advice Dates
03/11/2021
Added MA Bulletin numbered:
- 01-21-01 A Medical Assistance Bulletin entitled Administration of SARS-CoV-2 Vaccine Manufactured by Janssen Biotech, Inc.
Added the updated Pennsylvania Medicaid Managed Care Directory
02/22/2021
Added Managed Care Enrollment Information:
- Added January 2021
02/17/2021
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on February 24, 2021 at 1:00PM EDT - Register here.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on February 25, 2021 at 10:00AM EDT - Register here.
Added Provider Quick Tips - The following Quick Tips have been added to the website.
- 85 - Department of Human Services (DHS) Breast and Cervical Cancer Prevention and Treatment (BCCPT) Program (updated February 2021)
- 176 - Presumptive Eligibility for Pregnant Women - 2021 Income Limits
02/16/2021
Added Remittance Advice Dates - March 2021 Remittance Advice Dates
01/28/2021
Added Provider Quick Tips - The following Quick Tips have been added to the website.
01/26/2021
Added MA Bulletin numbered:
- 01-20-62 A Medical Assistance Bulletin entitled SARS-CoV-2 Vaccine Updates
Added Managed Care Enrollment Information:
- Added December 2020
01/25/2021
Added Provider Quick Tips - The following Quick Tips have been added to the website.
01/21/2021
Added Provider Quick Tips - The following Quick Tips have been added to the website.
- Updated #121 - Certification Renewal Required for Medical Assistance (MA) Providers Dispensing Hearing Aid Supplies (revised January 2021)
01/20/2021
Added Remittance Advice Dates - February 2021 Remittance Advice Dates
12/30/2020
Added MA Bulletin numbered:
- 01-20-60 A Medical Assistance Bulletin entitled SARS-CoV-2 Vaccine Administration by Pharmacists
12/24/2020
Added MA Bulletin numbered:
- 01-20-59 A Medical Assistance Bulletin entitled Addition to the Medical Assistance Program Fee Schedule for Administration of SARS-CoV-2 Vaccines
12/16/2020
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
12/15/2020
Added MA Bulletin numbered:
- 01-20-50 A Medical Assistance Bulletin entitled Prior Authorization of Crysvita (burosumab) - Pharmacy Services
- 01-20-51 A Medical Assistance Bulletin entitled Prior Authorization of Complement Inhibitors - Pharmacy Services
- 01-20-52 A Medical Assistance Bulletin entitled Prior Authorization of Corlanor (ivabradine) - Pharmacy Services
- 01-20-53 A Medical Assistance Bulletin entitled Prior Authorization of Spinraza (nusinersen) - Pharmacy Services
- 01-20-54 A Medical Assistance Bulletin entitled Prior Authorization of Tepezza (teprotumumab) - Pharmacy Services
12/14/2020
Added MA Bulletin numbered:
- 01-20-49 A Medical Assistance Bulletin entitled Prior Authorization of Cystic Fibrosis Transmembrane Regulator (CFTR) Modulators - Pharmacy Services
- 01-20-55 A Medical Assistance Bulletin entitled Prior Authorization of Duchenne Muscular Dystrophy (DMD) Antisense Oligonucleotides - Pharmacy Services
- 01-20-56 A Medical Assistance Bulletin entitled Prior Authorization of Evrysdi (risdiplam) - Pharmacy Services
- 01-20-57 A Medical Assistance Bulletin entitled Prior Authorization of Palforzia [peanut (Arachis hypogaea) allergen powder] - Pharmacy Services
- 01-20-58 A Medical Assistance Bulletin entitled Prior Authorization of Xyrem (sodium oxybate)/Xywav (calcium, magnesium, potassium, and sodium oxybates) - Pharmacy Services
Added Remittance Advice Dates - January 2021 Remittance Advice Dates
12/02/2020
Added MA Bulletin numbered:
- 27-20-01 A Medical Assistance Bulletin entitled Medical Assistance Program Dental Fee Schedule Update
11/24/2020
Added MA Bulletin numbered:
- 01-20-47 A Medical Assistance Bulletin entitled Prior Authorization of Cytokine and CAM antagonists - Pharmacy Services
- 01-20-48 A Medical Assistance Bulletin entitled Prior Authorization of Tysabri (natalizumab) - Pharmacy Services
Added Managed Care Enrollment Information:
- Added October 2020
11/16/2020
Added MA Bulletin numbered:
- 01-20-42 A Medical Assistance Bulletin entitled Prior Authorization of Sickle Cell Agents - Pharmacy Services
- 01-20-43 A Medical Assistance Bulletin entitled Statewide Preferred Drug List (PDL) Implementation - Pharmacy Services
- 01-20-44 A Medical Assistance Bulletin entitled Prior Authorization of Stimulants and Related Agents - Pharmacy Services
- 01-20-45 A Medical Assistance Bulletin entitled Prior Authorization of Synagis (palivizumab) - Pharmacy Services
11/13/2020
Added Remittance Advice Dates - December 2020 Remittance Advice Dates
Added MA Bulletin numbered:
- 01-20-38 A Medical Assistance Bulletin entitled Prior Authorization of Opioid Dependence Treatments - Pharmacy Services
- 01-20-39 A Medical Assistance Bulletin entitled Prior Authorization of Pituitary Suppressive Agents, LHRH - Pharmacy Services
- 01-20-40 A Medical Assistance Bulletin entitled Prior Authorization of Progestational Agents - Pharmacy Services
- 01-20-41 A Medical Assistance Bulletin entitled Prior Authorization of Sedative Hypnotics - Pharmacy Services
11/12/2020
Added MA Bulletin numbered:
- 99-20-03 A Medical Assistance Bulletin entitled 2020 Recommended Child and Adolescent Immunization Schedule
- 01-20-33 A Medical Assistance Bulletin entitled Prior Authorization of Lipotropics, Other - Pharmacy Services
- 01-20-34 A Medical Assistance Bulletin entitled Prior Authorization of Migraine Acute Treatment Agents (formerly Antimigraine Agents, Triptans) - Pharmacy Services
- 01-20-35 A Medical Assistance Bulletin entitled Prior Authorization of Migraine Prevention Agents (formerly Antimigraine Agents, Other) - Pharmacy Services
- 01-20-36 A Medical Assistance Bulletin entitled Prior Authorization of Multiple Sclerosis Agents- Pharmacy Services
- 01-20-37 A Medical Assistance Bulletin entitled Prior Authorization of NSAIDs - Pharmacy Services
11/10/2020
Added MA Bulletin numbered:
- 01-20-26 A Medical Assistance Bulletin entitled Prior Authorization of HIV/AIDS Antiretrovirals - Pharmacy Services
- 01-20-27 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemia Treatments - Pharmacy Services
- 01-20-28 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, SGLT2 Inhibitors - Pharmacy Services
- 01-20-29 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, Incretin Mimetics/Enhancers - Pharmacy Services
- 01-20-30 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, TZDs - Pharmacy Services
- 01-20-31 A Medical Assistance Bulletin entitled Prior Authorization of Idiopathic Pulmonary Fibrosis (IPF) Agents - Pharmacy Services
- 01-20-32 A Medical Assistance Bulletin entitled Prior Authorization of Intra-Articular Hyaluronates - Pharmacy Services
11/09/2020
Added MA Bulletin numbered:
- 01-20-17 A Medical Assistance Bulletin entitled Prior Authorization of Androgenic Agents - Pharmacy Services
- 01-20-18 A Medical Assistance Bulletin entitled Prior Authorization of Anticonvulsants - Pharmacy Services
- 01-20-19 A Medical Assistance Bulletin entitled Prior Authorization of antidepressants, Other - Pharmacy Services
- 01-20-20 A Medical Assistance Bulletin entitled Prior Authorization of Anxiolytics - Pharmacy Services
- 01-20-23 A Medical Assistance Bulletin entitled Prior Authorization of Hematopoietic Mixtures (Formerly Iron, Oral) - Pharmacy Services
- 01-20-24 A Medical Assistance Bulletin entitled Prior Authorization of Hepatitis C Agents - Pharmacy Services
- 01-20-25 A Medical Assistance Bulletin entitled Prior Authorization of Hereditary Angioedema (HAE) Agents - Pharmacy Services
11/06/2020
Added MA Bulletin numbered:
- 01-20-11 A Medical Assistance Bulletin entitled Prior Authorization of Analgesics, Non-Opioid Barbiturate Combinations - Pharmacy Services
- 01-20-12 A Medical Assistance Bulletin entitled Prior Authorization of Analgesics, Opioid Long-Acting - Pharmacy Services
- 01-20-13 A Medical Assistance Bulletin entitled Prior Authorization of Analgesics, Opioid Short-Acting - Pharmacy Services
- 01-20-14 A Medical Assistance Bulletin entitled Prior Authorization of Bone Density Regulators - Pharmacy Services
- 01-20-15 A Medical Assistance Bulletin entitled Prior Authorization of COPD Agents - Pharmacy Services
- 01-20-16 A Medical Assistance Bulletin entitled Prior Authorization of Estrogens - Pharmacy Services
- 01-20-22 A Medical Assistance Bulletin entitled Prior Authorization of H. Pylori Treatments - Pharmacy Services
10/19/2020
Added Managed Care Enrollment Information.
- Added September 2020
10/15/2020
Added Remittance Advice Dates - November 2020 Remittance Advice Dates
10/01/2020
Added MA Bulletin numbered:
- 24-20-02 A Medical Assistance Bulletin entitled COVID-19 Specimen Collection and Testing at Pharmacies
09/22/2020
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Added MA Bulletin numbered:
- 35-20-01 A Medical Assistance Bulletin entitled School-Based ACCESS Prgram Provider Handbook
09/17/2020
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on September 24, 2020 10:00AM EDT - Register here.
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on September 23, 2020 1:00PM EDT - Register here.
Added Managed Care Enrollment Information.
- Added August 2020
09/15/2020
Added MA Bulletin numbered:
- 08-20-03 A Medical Assistance Bulletin entitled Behavioral Health Group Therapy Provided in Federally Qualified Health Center and Rural Health Clinic Settings
- 08-20-04 A Medical Assistance Bulletin entitled Vision Services Provided in Federally Qualified Health Center and Rural Health Clinic Settings
09/11/2020
Added Remittance Advice Dates - October 2020 Remittance Advice Dates
09/10/2020
Added MA Bulletin numbered:
- 07-20-04 A Medical Assistance Bulletin entitled Electronic Visit Verification (EVV) for Personal Care Services (PCS)
09/08/2020
Added MA Bulletin numbered:
- 01-20-09 A Medical Assistance Bulletin entitled Specialty Pharmacy Drug Program Preferred Specialty Pharmacy Providers - Pharmacy Services
09/01/2020
Added Managed Care Enrollment Information.
- Added July 2020
08/26/2020
Added MA Bulletin numbered:
- 05-20-03 A Medical Assistance Bulletin entitled Electronic Visit Verification for Personal Care Services Provided in the Fee-for-Service Delivery System
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
08/14/2020
Added Remittance Advice Dates - September 2020 Remittance Advice Dates
Added Provider Quick Tip - The following Quick Tip has been added to the website.
08/12/2020
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
07/29/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
07/24/2020
Added Managed Care Enrollment Information.
07/17/2020
Added Remittance Advice Dates - August 2020 Remittance Advice Dates
Added Medical Assistance Advisory Committee Meeting minutes, agenda, and attachments - The June 2020 MAAC Webinar Audience Questions have been posted and can be accessed from the Meeting Minutes archives page.
07/08/2020
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on July 23, 2020 10:00AM EDT - Register here.
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on July 22, 2020 1:00PM EDT - Register here.
07/02/2020
Added MA Bulletin numbered:
- 01-20-08 A Medical Assistance Bulletin entitled Addition of Opioid Use Disorder Centers of Excellence Provider Specialty
06/26/2020
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
06/24/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #249 - New MA ACCESS Card
Added MA Bulletin numbered:
- 99-20-08 A Medical Assistance Bulletin entitled Update to the Medical Assistance ACCESS ID Card
06/18/2020
Added MA Bulletin numbered:
- 01-20-04 A Medical Assistance Bulletin entitled Updates to the Procedures for Presumptive Eligibility as Determined by Hospitals
06/16/2020
Provider's ordering MA Provider Forms Electronically
06/12/2020
Added MA Bulletin numbered:
- 99-20-07 A Medical Assistance Bulletin entitled “Payment in Full” and Personal Protective Equipment
06/11/2020
Added MA Bulletin numbered
- 05-20-02 A Medical Assistance Bulletin entitled Implementation of Electronic Visit Verification in the FFS and Physical Health Managed Care Delivery Systems
05/27/2020
Added MA Bulletin numbered:
- 01-20-07 A Medical Assistance Bulletin entitled Pharmacy Services for Medical Assistance Beneficiaries Related to the COVID-19 Public Health Emergency
05/26/2020
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Added MA Bulletin numbered:
- 99-20-02 A Medical Assistance Bulletin entitled 2020 Healthcare Common Procedure Coding System (HCPCS) Updates
- 99-20-04 A Medical Assistance Bulletin entitled Pennsylvania's Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
- 01-20-06 A Medical Assistance Bulletin entitled Updates to Childhood Nutrition and Weight Management Services
05/20/2020
Added MA Bulletin numbered:
- 99-20-06 A Medical Assistance Bulletin entitled ICD-10-CM Official Coding Guidelines Related to COVID-19
05/19/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
05/08/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
05/07/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #246 - Rescinding Prior Guidance on Elective Services
05/01/2020
Added MA Bulletin numbered:
- 09-20-05 A Medical Assistance Bulletin entitled Home Health Services, Medical Supplies, Equipment and Appliances Prescribed by Non-physician Practitioners
- 99-20-05 A Medical Assistance Bulletin entitled COVID-19 Testing and Related Treatment Exempt from MA Copayment Requirements
- 09-20-06 A Medical Assistance Bulletin entitled Addition of the Multi-Function Ventilator to the Medical Assistance Program Fee Schedule
- 01-20-05 A Medical Assistance Bulletin entitled Addition of Coronavirus Laboratory Test Codes to the MA Program Fee Schedule
04/30/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #245 - All Patient Refined-Diagnosis Related Group (APR-DRG) to be Updated with COVID-19 Billing Codes
04/17/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
04/16/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #243 - Use of the CR Modifier and DR Condition Code for COVID-19 Disaster/Emergency Related Claims
04/09/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #242 - Telemedicine Guidelines Related to COVID-19
- Added #241 - Prior Authorization Changes in the Medical Assistance Program for Certain Services during COVID0-19 Emergency Disaster
- Added #240 - Provider enrollment and revalidation changes during the COVID-19 emergency
04/07/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #239 - Short-acting beta agonist metered dose inhalers temporarily added to Statewide Preferred Drug List
- Added #238 - 90-Day Supplies of Medications - COVID-19
- Added #237 - Teledentistry Guidelines Related to COVID-19 for Dentists, Federally Qualified Health Centers and Rural Health
04/03/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Added #236 - Hydroxychloroquine Quantity Limits
12/31/2019
Added MA Bulletin numbered:
- 99-19-07 A Medical Assistance Bulletin entitled Place of Service Review and Updates to Surgical Services
12/10/2019
Added MA Bulletin numbered:
- 01-19-14 A Medical Assistance Bulletin entitled Billing for Inpatient Hospital and Short Procedure Unit Services When a MA Beneficiary is Directly Admitted from Observation
12/06/2019
Added MA Bulletin numbered:
- 01-19-100 A Medical Assistance Bulletin entitled Prior Authorization of Anti-Allergens, Oral-Pharmacy Services
- 01-19-106 A Medical Assistance Bulletin entitled Prior Authorization of Antimigraine Agents, Other-Pharmacy Services
- 01-19-116 A Medical Assistance Bulletin entitled Prior Authorization of Macular Degeneration Agents - Pharmacy Services
- 01-19-113 A Medical Assistance Bulletin entitled Prior Authorization of Pulmonary Arterial Hypertension (PAH) Agents, Oral and Inhaled - Pharmacy Services
- 01-19-101 A Medical Assistance Bulletin entitled Prior Authorization of Analgesics, Opioid Short-Acting - Pharmacy Services
- 01-19-109 A Medical Assistance Bulletin entitled Prior Authorization of Growth Hormones - Pharmacy Services
- 01-19-99 A Medical Assistance Bulletin entitled Prior Authorization of Antibiotics, GI and Related Agents - Pharmacy Services
Added MA Bulletin numbered:
- 01-19-29 A Medical Assistance Bulletin entitled Prior Authorization of Vitamin D Analogs – Pharmacy Services
- 01-19-41 A Medical Assistance Bulletin entitled Prior Authorization of Thrombopoietics – Pharmacy Services
- 01-19-31 A Medical Assistance Bulletin entitled Prior Authorization of Urinary Anti-Infectives – Pharmacy Services
- 99-19-06 A Medical Assistance Bulletin entitled Corrected - Diabetes Prevention Program Enrollment in the Medical Assistance Program
- 01-19-13 A Medical Assistance Bulletin entitled Family Planning Services Program
- 01-19-51 A Medical Assistance Bulletin entitled Prior Authorization of Antihistamines, Minimally Sedating – Pharmacy Services
- 01-19-50 A Medical Assistance Bulletin entitled Prior Authorization of Antihyperuricemics – Pharmacy Services
- 01-19-52 A Medical Assistance Bulletin entitled Prior Authorization of Antihemophilia Agents – Pharmacy Services
- 01-19-62 A Medical Assistance Bulletin entitled Prior Authorization of Intranasal Rhinitis Agents – Pharmacy Services
- 01-19-49 A Medical Assistance Bulletin entitledPrior Authorization of Bronchodilators, Beta Agonists – Pharmacy Services
- 01-19-53 A Medical Assistance Bulletin entitled Prior Authorization of Anticoagulants – Pharmacy Services
- 01-19-58 A Medical Assistance Bulletin entitled Prior Authorization of GI Motility, Chronic Agents – Pharmacy Services
- 01-19-54 A Medical Assistance Bulletin entitled Prior Authorization of Estrogens – Pharmacy Services
- 01-19-59 A Medical Assistance Bulletin entitled Prior Authorization of Oncology Agents, Breast Cancer – Pharmacy Services
- 01-19-61 A Medical Assistance Bulletin entitled Prior Authorization of Iron Chelating Agents – Pharmacy Services
- 01-19-60 A Medical Assistance Bulletin entitled Prior Authorization of Multiple Sclerosis Agents – Pharmacy Services
- 01-19-55 A Medical Assistance Bulletin entitled Prior Authorization of Sedative Hypnotics – Pharmacy Services
- 01-19-57 A Medical Assistance Bulletin entitled Prior Authorization of Urea Cycle Disorder Agents – Pharmacy Services
- 01-19-48 A Medical Assistance Bulletin entitledPrior Authorization of Ulcerative Colitis Agents – Pharmacy Services
- 01-19-56 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Anti-Inflammatories – Pharmacy Services
- 01-19-64 A Medical Assistance Bulletin entitled Prior Authorization of Stimulants and Related Agents – Pharmacy Services
- 01-19-47 A Medical Assistance Bulletin entitled Prior Authorization of Potassium Removing Agents – Pharmacy Services
- 01-19-63 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, Meglitinides – Pharmacy Services
- 35-19-01 A Medical Assistance Bulletin entitled School-Based ACCESS Program Provider Handbook
- 01-19-21 A Medical Assistance Bulletin entitled Updates to Sterilization Consent Form (MA 31)
- 01-19-65 A Medical Assistance Bulletin entitled Statewide Preferred Drug List (PDL) Implementation – Pharmacy Services
- 01-19-79 A Medical Assistance Bulletin entitled Prior Authorization of Glucocorticoids, Inhaled – Pharmacy Services
- 01-19-94 A Medical Assistance Bulletin entitledPrior Authorization of Antimigraine Agents, Triptans – Pharmacy Services
- 01-19-84 A Medical Assistance Bulletin entitled Prior Authorization of Blood Glucose Meters and Test Strips (Formerly Diabetic Meters and Diabetic Strips) – Pharmacy Services
- 01-19-86 A Medical Assistance Bulletin entitled Prior Authorization of Anticonvulsants – Pharmacy Services
- 01-19-83 A Medical Assistance Bulletin entitled Prior Authorization of Fluoroquinolones, Oral – Pharmacy Services
- 01-19-97 A Medical Assistance Bulletin entitledPrior Authorization of BPH Treatments – Pharmacy Services
- 01-19-82 A Medical Assistance Bulletin entitled Prior Authorization of Antifungals, Oral – Pharmacy Services
- 01-19-85 A Medical Assistance Bulletin entitled Prior Authorization of Antidepressants, SSRIs – Pharmacy Services
- 01-19-87 A Medical Assistance Bulletin entitled Prior Authorization of Acne Agents, Topical – Pharmacy Services
- 01-19-88 A Medical Assistance Bulletin entitled Prior Authorization of Antiemetic/Antivertigo Agents – Pharmacy Services
- 01-19-96 A Medical Assistance Bulletin entitled Prior Authorization of Histamine 2 (H2) Receptor Blockers – Pharmacy Services
- 01-19-78 A Medical Assistance Bulletin entitled Prior Authorization of Growth Factors – Pharmacy Services
- 01-19-76 A Medical Assistance Bulletin entitled Prior Authorization of Immunosuppressives, Oral – Pharmacy Services
- 01-19-81 A Medical Assistance Bulletin entitled Prior Authorization of Intra-Articular Hyaluronates – Pharmacy Services
- 01-19-77 A Medical Assistance Bulletin entitled Prior Authorization of Idiopathic Pulmonary Fibrosis (IPF) Agents – Pharmacy Services
- 01-19-72 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Allergic Conjunctivitis (Formerly Ophthalmic Agents for Allergic Conjunctivitis) – Pharmacy Services
- 01-19-68 A Medical Assistance Bulletin entitledPrior Authorization of Ophthalmics, Immunomodulators (Formerly Ophthalmic Immunomodulators) – Pharmacy Services
- 01-19-74 A Medical Assistance Bulletin entitled Prior Authorization of Macrolides (Formerly Macrolides/Ketolides) – Pharmacy Services
- 01-19-75 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Glaucoma (Formerly Ophthalmic Agents for Glaucoma) – Pharmacy Services
- 01-19-67 A Medical Assistance Bulletin entitledPrior Authorization of Opioid Overdose Agents (Formerly Opiate Overdose Agents) – Pharmacy Services
- 01-19-71 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Antibiotics (Formerly Ophthalmic Antibiotics) – Pharmacy Services
- 01-19-95 A Medical Assistance Bulletin entitled Prior Authorization of Iron, Oral - Pharmacy Services
- 01-19-80 A Medical Assistance Bulletin entitled Prior Authorization of Iron, Parenteral – Pharmacy Services
- 01-19-70 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Antibiotic-Steroid Combinations (Formerly Ophthalmic Antibiotic-Steroid Combinations) – Pharmacy Services
- 01-19-73 A Medical Assistance Bulletin entitled Prior Authorization of Neuropathic Pain Agents – Pharmacy Services
- 01-19-66 A Medical Assistance Bulletin entitled Prior Authorization of Otic Antibiotics (Formerly Otic Antibiotic Preparations) – Pharmacy Services
- 01-19-93 A Medical Assistance Bulletin entitled Prior Authorization of Proton Pump Inhibitors (PPIs) - Pharmacy Services
- 01-19-92 A Medical Assistance Bulletin entitled Prior Authorization of Prenatal Vitamins – Pharmacy Services
- 27-19-17 A Medical Assistance Bulletin entitled Medical Assistance Program Dental Fee Schedule and Dental Provider Handbook Update
- 01-19-90 A Medical Assistance Bulletin entitled Prior Authorization of Steroids, Topical (Formerly Steroids, Topical Low; Steroids, Topical Medium;Steroids, Topical High; and Steroids, Topical Very High) – Pharmacy Services
- 01-19-91 A Medical Assistance Bulletin entitled Prior Authorization of Tetracyclines – Pharmacy Services
- 01-19-89 A Medical Assistance Bulletin entitled Prior Authorization of Skeletal Muscle Relaxants – Pharmacy Services
- 01-19-69 A Medical Assistance Bulletin entitled Prior Authorization of Pancreatic Enzymes – Pharmacy Services
- OMHSAS-19-03 A Medical Assistance Bulletin entitled Guidelines for Implementing Assisted Outpatient Treatment
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
- Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
- Community Support Service Providers - Federal Financial Participation Rate Change and Continued Billing Requirements
Added Remittance Advice Dates
- September 2019 Remittance Advice Dates
- October 2019 Remittance Advice Dates
- November 2019 Remittance Advice Dates
Added Provider Quick Tip - The following Quick Tip has been added to the website.
- Updated #11 - The Eligibility Verification System (EVS)
Added Managed Care Delivery System Subcommittee agenda, draft file note and attachment - The September 2019 Managed Care Delivery System Subcommittee agenda and July 2019 draft file note and attachment have been posted and can be accessed from the Meeting Minutes archives page
Added Managed Care Delivery System Subcommittee agenda, draft file note and attachment - The October 2019 Managed Care Delivery System Subcommittee agenda and September 2019 draft file note and attachment have been posted and can be accessed from the Meeting Minutes archives page
Added the Fee-for-Service Subcommittee Meeting minutes - The August 2019 Fee-for-Service Subcommittee minutes have been posted and can be accessed from the Meeting Minutes archives page.
11/09/2019
Added MA Bulletin numbered:
- 00-19-03 A Medical Assistance Bulletin entitled Prioritization of Urgency of Need for Services (PUNS) Manual
- OMHSAS-19-02 A Medical Assistance Bulletin entitled Service Location Enrollment for Behavioral Health Providers
- 01-19-37 A Medical Assistance Bulletin entitled Prior Authorization of Antimigraine Agents, Other - Pharmacy Services
- 01-19-34 A Medical Assistance Bulletin entitled Prior Authorization of Acne Agents, Oral - Pharmacy Services
- 01-19-39 A Medical Assistance Bulletin entitled Prior Authorization of Antianginal Agents - Pharmacy Services
- 01-19-38 A Medical Assistance Bulletin entitled Prior Authorization of Antimalarials - Pharmacy Services
- 01-19-40 A Medical Assistance Bulletin entitled Prior Authorization of Angiotensin Modulators - Pharmacy Services
- 00-19-12 A Medical Assistance Bulletin entitled Notification Protocol for Formal Licensing Actions and Incidents
- OMHSAS-19-03 A Medical Assistance Bulletin entitled Serious Mental Illness: Adult Priority Group
- 01-19-27 A Medical Assistance Bulletin entitled Prior Authorization of Colony Stimulating Factors - Pharmacy Services
- 01-19-22 A Medical Assistance Bulletin entitled Prior Authorization of Thalidomide and Derivatives - Pharmacy Services
- 01-19-26 A Medical Assistance Bulletin entitled Prior Authorization of HIV/AIDS Antiretrovirals - Pharmacy Services
- 01-19-24 A Medical Assistance Bulletin entitled Prior Authorization of Monoclonal Antibodies - Anti-IL, Anti-lgE (MABs - Anti-IL, anti-IgE) - Pharmacy Services
- 01-19-28 A Medical Assistance Bulletin entitled Prior Authorization of Cephalosporins - Pharmacy Services
- 01-19-25 A Medical Assistance Bulletin entitled Prior Authorization of Local Anesthetics, Topical - Pharmacy Services
- 01-19-23 A Medical Assistance Bulletin entitled Prior Authorization of Penicillins - Pharmacy Services
- 99-19-02 A Medical Assistance Bulletinentitled Pennsylvania's Early and Periodic screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
- 99-19-04 A Medical Assistance Bulletin entitled 2019 Healthcare Common Procedure Coding System(HCPCS) Updates, Fee Adjustments and Other Procedure Code Changes
- 01-19-32 A Medical Assistance Bulletin entitled Prior Authorization of Bone Density Regulators - Pharmacy Services
- 01-19-35 A Medical Assistance Bulletin entitled Prior Authorization of Antivirals, Herpes - Pharmacy Services
- 01-19-44 A Medical Assistance Bulletin entitled Prior Authorization of H. Pylori Treatments - Pharmacy Services
- 01-19-36 A Medical Assistance Bulletin entitled Prior Authorization of Antivirals, CMV - Pharmacy Services
- 01-19-33 A Medical Assistance Bulletin entitled Prior Authorization of Antivirals, influenza - Pharmacy Services
- 01-19-42 A Medical Assistance Bulletin entitled Prior Authorization of COPD Agents - Pharmacy Services
- 01-19-43 A Medical Assistance Bulletin entitled Prior Authorization of Antipsychotics - Pharmacy Services
- 01-19-30 A Medical Assistance Bulletin entitled Prior Authorization of Vaginal Anti-infectives - Pharmacy
7/18/19
Added MA Bulletin numbered:
- 01-19-15 A Medical Assistance Bulletin entitled Prior Authorization of Antibiotics, Inhaled – Pharmacy Services
- 01-19-16 A Medical Assistance Bulletin entitled Prior Authorization of Dupixent (dupilumab) – Pharmacy Services
- 01-19-17 A Medical Assistance Bulletin entitled Prior Authorization of Immunomodulators, Atopic Dermatitis – Pharmacy
- 01-19-18 A Medical Assistance Bulletin entitled Prior Authorization of Xyrem (sodium oxybate) – Pharmacy Services
- 01-19-19 A Medical Assistance Bulletin entitled Prior Authorization of Complement Inhibitors – Pharmacy Services
- 01-19-20 A Medical Assistance Bulletin entitled Prior Authorization of Calcium Channel Blockers – Pharmacy Services
- 99-19-13 A Medical Assistance Bulletin entitled Diabetes Prevention Program Enrollment in the Medical Assistance Program
- 01-19-45 A Medical Assistance Bulletin entitled Medical Marijuana and State Licensure of Facilities and Agencies
- 01-19-46 A Medical Assistance Bulletin entitled Certified Recovery Specialists in Centers of Excellence
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
- Revisions to Participating Drug Company List for MA Drug Rebate
- Eligibility Verification System Issue
Added Remittance Advice Dates
- August 2019 Remittance Advice Dates
Added Managed Care Delivery System Subcommittee Meeting Agenda and Draft File Note - the July 2019 Managed Care Delivery System Subcommittee Agenda and Draft File Note have been posted and can be accessed from the Meeting Minutes archives page
6/20/19
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added Medical Assistance Advisory Committee Meeting minutes - The May 2019 Medical Assistance Advisory Committee minutes have been posted and can be accessed from the Meeting Minutes archives page.
Added Managed Care Delivery System Subcommittee agenda and draft file note - The June 2019 Managed Care Delivery System Subcommittee agenda and May 2019 draft file note have been posted and can be accessed from the Meeting Minutes archives page.
5/23/19
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added Medical Assistance Advisory Committee Meeting agenda, minutes and attachments - The May 2019 Medical Assistance Advisory Committee agenda and April 2019 minutes and attachments have been posted and can be accessed from the Meeting Minutes archives page.
Added Managed Care Delivery System Subcommittee agenda and draft file note - The May 2019 Managed Care Delivery System Subcommittee agenda and April 2019 draft file note have been posted and can be accessed from the Meeting Minutes archives page.
Added the Fee-for-Service Subcommittee Meeting minutes - The May 2019 Fee-for-Service Subcommittee minutes have been posted and can be accessed from the Meeting Minutes archives page.
Added Pharmacy and Therapeutics Committee Meeting minutes - The November 2018 Pharmacy and Therapeutic Committee Meeting minutes have been posted and can be accessed from the Meeting Minutes archives page.
4/25/19
Added MA Bulletin numbered:
- 99-19-01 A Medical Assistance Bulletin entitled 2019 Recommended Childhood and Adolescent Immunization Schedule
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
- Date of Death Recovery
- ESRD Transitional Drug Adjustment from Medicare
Added Medical Assistance Advisory Committee Meeting agenda, minutes and attachments - The April 2019 Medical Assistance Advisory Committee agenda and March 2019 minutes and attachments have been posted and can be accessed from the Meeting Minutes archives page.
4/11/19
Added MA Bulletin numbered:
- 01-19-11 A Medical Assistance Bulletin entitled Update to the Administration of the Human Papillomavirus (HPV) Vaccine
Added Remittance Advice Alert - The following Remittance Advice Alert/PROMISe™ Banner page has been added to the website.
- Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added Managed Care Delivery System Subcommittee agenda and draft file note - The April 2019 Managed Care Delivery System Subcommittee agenda and March 2019 draft file note have been posted and can be accessed from the Meeting Minutes archives page.
3/28/19
Added Remittance Advice Alert - The following Remittance Advice Alert/PROMISe™ Banner page has been added to the website.
- Fee-for-Service Relative Weight Adjustments
Added Medical Assistance Advisory Committee Meeting minutes, agenda, and attachments - The December 2018 and January and February 2019 Medical Assistance Advisory Committee minutes and March 2019 agenda and attachments have been posted and can be accessed from the Meeting Minutes archives page.
Added Consumer Subcommittee Meeting agenda and attachment - The March 2019 Consumer Subcommittee agenda and attachment have been posted and can be accessed from the Meeting Minutes archives page.
Added Drug Utilization Review Board minutes - The September 2018 Drug Utilization Review Board minutes have been posted and can be accessed from the Meeting Minutes archives page.
3/14/19
Added MA Bulletin numbered:
- 01-19-12 A Medical Assistance Bulletin entitled Changes to Third-Party Liability Requirements for Claims for Prenatal Services
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added Managed Care Delivery System Subcommittee agenda, draft file note and attachment - The March 2019 Managed Care Delivery System Subcommittee agenda and February 2019 draft file note and attachment have been posted and can be accessed from the Meeting Minutes archives page.
2/28/19
Added Remittance Advice Alert - The following Remittance Advice Alert/PROMISe™ Banner page has been added to the website.
- Implementation of the All-Patient Refined Diagnosis Related Group version 36
Added Medical Assistance Advisory Committee Meeting agenda - The February 2019 Medical Assistance Advisory Committee agenda has been posted and can be accessed from the Meeting Minutes archives page.
Added the Fee-for-Service Subcommittee Meeting minutes - The February 2019 Fee-for-Service Subcommittee minutes have been posted and can be accessed from the Meeting Minutes archives page.
Added Managed Care Delivery System Subcommittee agenda and draft file note - The February 2019 Managed Care Delivery System Subcommittee agenda and January 2019 draft file note have been posted and can be accessed from the Meeting Minutes archives page.
Added Provider Quick Tips - The following Quick Tips have been added to the website.
Added Medical Assistance Advisory Committee Meeting agenda and attachments - The January 2019 Medical Assistance Advisory Committee agenda and attachments have been posted and can be accessed from the Meeting Minutes archives page.
1/22/19
Added MA Bulletins numbered:
- 01-19-02 A Medical Assistance Bulletin entitled Prior Authorization of Symdeko (tezacaftor/ivacaftor) – Pharmacy Services
- 01-19-03 A Medical Assistance Bulletin entitled Prior Authorization of Radicava (edaravone) – Pharmacy Services
- 01-19-04 A Medical Assistance Bulletin entitled Preferred Drug List (PDL) Update January 28, 2019 - Pharmacy Services
- 01-19-05 A Medical Assistance Bulletin entitled Prior Authorization of Antihyperuricemics – Pharmacy Services
- 01-19-06 A Medical Assistance Bulletin entitled Prior Authorization of Anticonvulsants - Pharmacy Services
- 01-19-07 A Medical Assistance Bulletin entitled Prior Authorization of Pulmonary Arterial Hypertension (PAH) Agents, Oral and Inhaled – Pharmacy Services
- 01-19-08 A Medical Assistance Bulletin entitled Prior Authorization of Alpha-1 Proteinase Inhibitors – Pharmacy Services
- 01-19-09 A Medical Assistance Bulletin entitled