Quick Tips for Medicaid Providers

Below are links to documents that contain helpful tips for Medicaid providers and their staff. 

Tip No. 

Topic

274Ambulance Services Update
273Benefit Limit Exception Process for Certain Dental Services Reminder
272Delayed Implementation of All Patient Refined-Diagnosis Related Group (APR DRG) Versions 40 & 41
271Medical Assistance Coverage of Zulresso (brexanolone) and Zurzuvae (zuranolone)
270Revalidation of Multiple Locations
269 Incontinence Products Billing Reminder
268Reminder for Prescribers and Providers to Request Prior Authorization for Processing Codes L1851 and L1852
267Delayed Implementation of All Patient Refined Diagnosis Related Group (APR DRG) Version 38 & 39
266New Group Provider Access for Reactivation/Revalidation Changes of Group Members (Fee Assigned Practitioners)
265How to Check the Status of Your Electronic Provider Enrollment Application/Actions to Take if Your Application Was Returned for Additional Information
264Electronic Visit Verification 
263180 Day Exception Electronic Process   Updated 08/01/2023
262Provider Enrollment Summary Enhancements
261Important Changes are Coming for the Physical Health HealthChoices Program
260Provider Electronic Portal Update
259Documentation for Shift Nursing (SN) and Home Health Aide (HHA) Prior Authorization and Program Exception Requests in the Fee for Service (FFS) Delivery System
258Provider Electronic Solutions Software
257Medicare Sequestration Payment Reductions on All Claims Media Fee For Service (FFS) Claims Reinstated
256Procedure 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)
255Provider Revalidation Requirements
254Payment Error Rate Measurement (PERM) Initiative for RY 2025
253Year 2020 Pennsylvania Medicaid 1099s issued by PROMISeTM
252Medical Assistance Benefits for Beneficiaries Turning 21 During the COVID 19 Emergency
251Medical Assistance Benefits for Beneficiaries Turning 21 During the COVID 19 Emergency
250Version 37.1 of All Patient Refined Diagnosis Related Group (APR DRG) Implementation
249New MA ACCESS Card
248DexCom Continuous Glucose Monitoring Products Coverage
247Nonemergency Ambulance Transportation Related to COVID 19
246Rescinding Prior Guidance on Elective Services
245All Patient Refined Diagnosis Related Group (APR DRG) to be Updated with COVID 19 Billing Codes
244MA Eligibility During COVID 19 Emergency Disaster Declaration 
243Use of the CR Modifier and DR Condition Code for COVID 19 Disaster/Emergency Related Claims
242Telemedicine Guidelines Related to COVID 19
241Prior Authorization Changes in the Medical Assistance Program for Certain Services during COVID0 19 Emergency Disaster
240Provider enrollment and revalidation changes during the COVID 19 emergency
239Short acting beta agonist metered dose inhalers temporarily added to Statewide Preferred Drug List 
23890 Day Supplies of Medications   COVID 19
237Teledentistry Guidelines Related to COVID 19 for Dentists, Federally Qualified Health Centers and Rural Health Clinics
236Hydroxychloroquine Quantity Limits   COVID 19 
235Elective services should not be provided during the COVID 19 emergency disaster
234New ICD 10 CM code or the 2019 Novel Coronavirus (COVID 19) Effective April 1, 2020
233Waiver of Prudent Pay during COVID 19 emergency
232Billing Guidance for Alternative Screening Sites Related to COVID 19
231Directions to bypass the prior authorization requirements for CT Scans of the Chest for COVID 19 patients
230COVID 19 Response: Pharmacies May Override Early Refill Alerts for Medications
229Telemedicine Guidelines Related to COVID 19
228ICD 10 CM Official Coding Guidelines Related to COVID 19
227Provider Enrollment Updating Documentation Requirements
226Version 37 of all Patient Refined Diagnosis Related Group (APR DRG) Implementation
225The Auditor General is conducting performance audits
224Billing for Tobacco Cessation Counseling Services provided by Pharmacists
223Availability of the Provider Directory on the Department of Human Services Website
222New Electronic Benefit Transfer Card
221Common Billing Issues Which May Result in Denied Claims as of July 2019
220Version 36 of All Patient Refined Diagnosis Related Group (APR DRG) Implementation
219Service Location Enrollment Deadline
218Provider Enrollment File Information Changes
217Provider Enrollment Application Update
216Reminder: Hospital Adverse Determination Summary Requirement
215Payment Error Rate Measurement (PERM) Initiative for RY 2019
214Non Emergency Ambulance Transportation
213Professional Claims Mapping of NPI for Rendering Providers
212Medicare and Medicare Advantage Crossover Claims for Certified Registered Nurse Practitioners (CRNP) and Physician Assistants (PA)
211Medical Assistance (MA) Update for ASC X12N 276/277 (Claim Status Inquiry/Claim Status Response)
210Version 35 of All Patient Refined Diagnosis Related Group (APR DRG) Implementation
209Crossover Claims: Qualified Medicare Beneficiary (QMB) Program CARC 209 and Cost Sharing*
208Crossover Claims: Ordering and Referring Providers
207MA Program Fee Schedule Updates for Act 62 Procedure Codes
206Medical Assistance Phone Options Update
205Mid Level Practitioner: Provider Electronic Portal Update
204IMPORTANT MESSAGE: Claims Submitted by Billing Providers Must Contain the National Provider Identifier (NPI) of the Medical Assistance (MA) Enrolled Ordering, Referring or Prescribing Provider
203 Provider Electronic Solutions (PES) Mandatory Upgrade Available March 17, 2017
202 Version 34 of All Patient Refined Diagnosis Related Group (APR DRG) Implementation
201 Medical Assistance (MA) Fee Schedule Updates for Certain Family Planning Services
200 Valid Zip Code On Electronic Claims and Encounters 
199 Ordering, Referring or Prescribing Providers
198 Medical Assistance (MA) Provider Groups Must Be Revalidated
196 Electronic Provider Enrollment Application "Copy" Function Released
195 Additional Information on the Provider Enrollment Application Fee
194 Enrollment of Physician Assistants
193 Updated List of Providers Unable to Apply via the Electronic Provider Portal
192 Observation Services
191 Reporting of Pregnancy On All Claim Types
190 Announcing the Electronic Provider Enrollment Application
189 Version 33 of All Patient Refined Diagnosis Related Group (APR DRG) Implementation
188 Revised Procedures for Presumptive Eligibility as Determined by Hospitals
187 Valid ICD 10 Diagnosis Required on Laboratory Claims
186 Reminder: Diagnosis Qualifier Required for Professional and Institutional Claims
185 ICD 10 Prior Authorizations
184 ICD 10 Span Date Billing for Outpatient and Professional Services
183 ICD 10 and Atypical Providers
182 ICD 10 Claims Compliance Date
181 Provider Electronic Solutions (PES) New Version Available August 31, 2015
180 Affordable Care Act (ACA) Provider Revalidation of All Provider Types Including All Associated Service Locations
179 Version 31 of All Patient Refined Diagnosis Related Group (APR DRG) Effective July 1, 2015
178 Payment Error Rate Measurement (PERM) Initiative for FFY 2015
177 Medicare Dual Eligible Claims with Duplicate CARC (Claim Adjustment Reason Code) CO 237
176 Presumptive Eligibility for Pregnant Women   2023 Income Limits
175 Incomplete Provider Enrollment Applications will be Returned Effective February 1, 2015
174 Limits on Medical Surgical Consultations During Inpatient Stay
173 All Medical Assistance (MA) Providers MUST Enroll & Update all Service Locations with the Department of Human Services (the department) as Well as Providers With Managed Care Organizations (MCOs)
172 Announcing Provider Revalidation Date Fields on Your Provider Profile
171 ICD 10 Checklist Get Ready! Less than 70 Days Left Before the Mandatory 10/1/2015 Implementation Date — (Revised July 2015)
170 Medicare Sequestration Payment Reductions on All Claims Media Fee for Service (FFS) Claims 
169 Department of Human Services (the department) Breast and Cervical Cancer Prevention and Treatment (BCCPT) Program Mailing address change for the BCCPT Renewal Form
168 Provider Enrollment Application Requirement
167 Electronic Enrollment for Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA)
166 Addenda Record for Electronic Funds Transfer (EFT)
164 Most Common Billing Errors for Drugs Covered Under the Medical Assistance (MA) Program
163 Electronic Remittance Advice (ERA) Delivery Date Change
162 Revised CMS 1500 Form — (February 2012)
161 Medicare Sequestration Reductions on Fee for Service (FFS) Claims Processing and Related Clarification of Medical Assistance (MA) 539 Form (11/13) Usage
160 Health Insurance Portability and Accountability Act of 1996 (HIPAA) Upgrade to ICD 10 Diagnosis & Surgical Procedure Codes is Coming! Get Ready! — (Revised September 30, 2015)
159 Implementation of American Dental Association (ADA) Claim Form   Version 2012
158 Provider Enrollment Application Requirement
157 Hospital Payment Arrangement 1 and 2 for Emergency Room 
156 Provider Electronic Solutions (PES) Software v3.60 Replaces v3.59
155 Announcing the New Medical Assistance (MA) Enrolled Provider Portal Lookup Function
154 Centers for Medicare and Medicaid Services (CMS) Creates New Medicaid National Correct Coding Initiative (NCCI) Procedure to Procedure Edits Related to Wheelchairs Effective October 1, 2012
153 Pennsylvania (PA) Medical Assistance (MA) Clinical Laboratory Improvement Amendments (CLIA) Requirements
152 Medical Assistance (MA) Increased Fees for Primary Care Services for Calendar Years 2013 2014, Physician Provider Type 31, Provider Specialties 316, 322 & 345
151 Name Change for AmeriHealth Mercy Health Plan and Keystone Mercy Health Plan
150 Provider Enrollment Application Requirement Effective January 21, 2013
149 Billing of Multiple Anesthesia Services
148 CAQH/CORE Changes to 270/271 Eligibility Transactions
146 Statewide Obstetrical Needs Assessment Form (ONAF) Update
145 The ACCESS Card is not Going Away
144 Eligibility Verification System (EVS) Search Enhancement
143 Medical Assistance (MA) Providers and Managed Care Organizations (MCOs) Must Ensure Continuity of Care During HealthChoices (HC) New East Zone Expansion
142 HealthChoices Physical Health Expansion to the New East Zone March 2013
141 Delaying the Copay for Alternative Cost Sharing for Families of Children with Disabilities with Incomes Over 200% of the Federal Poverty Income Guidelines
139 Attention Medical Assistance (MA) Dental Providers
138 Medical Assistance (MA) Providers and Managed Care Organizations (MCOs) Must Ensure Continuity of Care During HealthChoices (HC) Expansion
137 Billing of Multiple Surgical Services
136 Billing Primary Procedure Code with Add on Code(s)
135 HealthChoices Physical Health Expansion to the New West Zone
134 Low Cost Outlier Implementation and High Cost Outlier Threshold Adjustment
133 Emergency Supply of a Prescription That Requires Prior Authorization (PA) or a Benefit Limit Exception (BLE)
132 Updates to the Medical Assistance (MA) Program Fee Schedule for Hospital Based Clinic Services
131 Miscellaneous Healthcare Common Procedure Coding System (HCPCS) Procedure Codes B9998, E1399 and K0108 with Specific Modifiers Are Assigned to Distinct Items on the Medical Assistance (MA) Program Fee Schedule
130 The ANSI X12 v5010/D.0 Certification Help Desk will be Discontinued as of March 30, 2012
128 Non Emergency Ambulance Transportation – Appropriate Use of Place of Service (POS) and Modifier for Nursing Facility Recipients
127 Provider Electronic Solutions (PES) Software v3.59 replaces v3.58
126 HealthChoices is Expanding to your County in 2012
125 Reporting Ambulance Pick up/Drop Off Point of Service
123 Medical Assistance (MA) Claims for Ambulance Transport to Inpatient Hospital Facilities
122 Medical Assistance (MA) Outpatient Online Fee Schedule
121 Certification Renewal Required for Medical Assistance (MA) Providers Dispensing Hearing Aid Supplies (revised February 2023)
120 Waiving of the Certification Requirements for ANSI X12 v5010 and NCPDP D.0 for current electronic claim submitters
119 PROMISe™ Internet Adjustments, Voids and Resubmissions Beginning January 1, 2012
117 Medical Assistance (MA) Phone Number Changes
116 Compliance Date for ANSI X12 v5010/NCPDP vD.0 IS January 1, 2012; Pennsylvania will Implement January 1, 2012
115 Medical Assistance Inpatient Hospital Claims Secondary to Medicare Include 3 Day (72 hour) Payment Rule
114 Fee For Service Relative Weight Adjustment
113 Changes to Diagnosis Code Edits
112 Reprocessing Procedure Code 90999 Claims
111 Discontinued Mailing of Medical Assistance Bulletins
110 Medical Assistance Dental Benefit Changes
109 Is it Necessary to Certify for X12 v5010 Transactions?
108 Pediatric Palliative and Hospice Care Task Force
107 Medical Assistance Health Information Technology Initiative Electronic Health Record Incentive Program
106 PES Software Upgrade
105 APR DRG Implementation to Begin on March 4, 2011
104 2 25 45393 DRG Implementation DELAYED
1031099 MISC   Information for Providers
102 As DHS Moves from DRG to APR DRG
100 ANSI v5010/NCPDP D.0 Recertification
98 Providing Services for Recipients who are Locked In to a Physician, Pharmacy or Hospital
96 New Web Site Coming in October!
95 Clarification on the Change in Protocol for Certain Provider Appeals
94 Pennsylvania PROMISe ANSI X12 v5010 Companion Guides 
92 PROMISe™ New Internet Portal
91 PROMISe Certification for ANSI 5010 and NCPDP D.0
89 HIPAA Upgrades to ANSI X12 v5010 & NCPDP D.0 are coming! Get Ready!
87 Medical Assistance (MA) Providers are reminded to make sure MA contact information is up to date
85 Department of Human Services (DHS) Breast & Cervical Cancer Prevention & Treatment (BCCPT) Program Updated July 2023
84 HCBP 15 SelectPlan for Women Provides Limited Coverage
82 Reminder to Medical Assistance (MA) Providers Filing National Provider Identifier (NPI) Electronic Claims
81 Copayment Desk Reference Clarification
80 Attention: All Healthy Beginnings Plus Providers 
79 ICD 9 Codes E849.0   E849.9 (Place of Occurrence)
77 Medicaid Integrity Contractor (MIC) Audits
76 Reporting Diagnosis Codes for Immunization Administration
75 Pennsylvania PROMISe   835 Remittance Advice Companion Guide
74 Diagnosis Codes are Required on Most Medical Assistance Claims
72 National Provider Identifier (NPI) Requirements For Electronic Claims
71 The Department of Human Services (DHS) Encourages Providers to go Electronic and Support the Go Green Initiative!
69 Medical Assistance (MA) Claims for Advanced Radiologic Imaging Services
68 Using the 50 Modifier on Medical Assistance Claims
67 Prior Auth. Requirements for Effective Non Fee Schedule Surgical Procedures Effective Aug. 1, 2008
66 Early Periodic Screening, Diagnosis & Treatment (EPSDT) & Error Status Code 771
65 Early & Periodic Screening, Diagnosis & Treatment (EPSDT) Billing Assistance for FQHCs
64 For Medical Assistance (MA) Providers Submitting MA Claims For Prior Authorized Services
63 Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Billing Assistance
62 NPI and Paper Claim forms: CMS 1500 (Professional)& UB 04 (Institutional)
60 Place of Service Review (PSR) requests for Short Procedure Units (SPUs)
59 Information For Healthy Beginnings Providers
56 Most Common Errors Made On the Prior Authorization / MA 97 Form
55 Federal Requirements for Outpatient Drug Prescriptions for MA Recipients
53 Electronic Funds Transfer (EFT) Sign Up Today!!
52 MA Recipient Drug Prescriptions Must be Written on Tamper Resistant Prescription Pads
51 Dental Behavior Management Billing Reminders 
47 Attention: DME Suppliers, Independent Labs, and Mobile X Ray Providers
46 Attention, New Healthcare Providers Requesting Medical Assistance (MA) Enrollment
45 National Provider Identifier (NPI) Legacy Dual Strategy
44 Correctly Reporting Value Codes on the UB 04 Claim Form to Ensure Smooth Claims Processing
43 Now Receive Medical Assistance (MA) Bulletin Notifications Via Email!
42 Eligibility Verification System (EVS) Reminder
41 Medical Assistance Desk Reference Guide (Updated April 2023)
40 New Downloadable Outpatient Fee Schedule
39 Provider Data Elements Expected on HIPAA Covered Transactions
38 Attention, All Healthcare Providers: You MUST Register an NPI Number with DHS
35 The PROMISe Outpatient Fee Schedule is Online
32 Atypical Providers
31 New Option on ePeap!
27 National Provider Identifier (NPI) Taxonomy Codes
26 Securing National Provider Identifier (NPI) Numbers for Subparts
25 Access Plus Referral Requirements Effective November 1, 2006
24 NPI and Paper Claim Forms
23 Federal Medicaid Citizenship and Identity Eligibility Requirements
21 You Can Stop Receiving Paper Remittance AS (RAs)
17 Scope of Coverage of Pharmacy Services: Medical Assistance Dual Eligibles
15 Copayments for Prescription Drugs
12 Do You Need to Send an Attachment for an Electronic Claim?
11 The Eligibility Verification System (EVS)
10 ePEAP (electronic Provider Enrollment Automation Project)
7 Are You Puzzled by Your Remittance Advice Statement?

Long Term Living Providers

5Provider Electronic Software (PES) Questions and Answers
4Medicare Questions and Answers
3Billing Quesitons and Answers
2UB-04 Questions and Answers
1General Questions and Answers