Part 3
Contents
1. After you enter a valid 13 digit number and a valid 4 digt PIN from the old ePEAP system you will be prompted with the account maintenance window and should change this 4 digit PIN to anew PROMISe password You are then logged into the website and can perform the available functions If you do not know what the old password PIN was you should click on the forget password link It will walk you through resetting your password This can only be done however if you are able to provide the valid provider number and SSN or FEIN information Please note that if you attempt to logon unsuccessfully for 6 times you will be locked out and will need to contact the DPW Inquiry lines who will request that your account be reset Also if you continue to experience problems or have questions regarding the registration process please refer to the Provider Internet User Manual found under the Help tab This has recently been added to the website ISSUE Are there any restrictions to how many logins we can have Estimate 20 staff needing access for eligibility and billing purposes RESPONSE No for your first logon you will use your 13 digit PROMISe provider number and you will have the ability to set up alternate accounts without limitations or restrictions If you so choose you can have all staff members access the site using a single logon and password 2004 Pennsylvania Community Providers Association 2400 Park Drive Harris2. MA RAs How can this be corrected RESPONSE If you are receiving rejections because EVS states that the recipient has a third party resource e g Blue Cross Aetna etc and the recipient is no longer covered by the third party resource the recipient must contact their County Assistance Office to have the third party resource removed from their file In the meantime providers must bill the primary insurance for the denial and use Attachment Type Code 11 on the CMS 1500 If billing electronically use the reason code from the EOB or 835 in the appropriate TPL loops Please note that providers must keep copies of EOBs EOMBs on file for a period of at least four years as per Chapter 1101 51 e ISSUE What is the turnaround time for payments RESPONSE The turnaround time for payments has not changed Remittance Advice Statements and checks will be mailed within 31 45 days of claim submission However the PROMISe Internet site will allow you to view claim status which will assist you in forecasting monthly revenue I SSUE Please discuss protocols in changing provider data information RESPONSE The protocols for changing provider data information varies based on the type of change We recommend you read the information available on the OMAP website regarding provider enrollment and the new PROMISe Provider Enrollment Application For address changes and pay to and mail to modifications the ePEAP Internet application is available to
3. digit number and a valid 4 digt PIN from the old ePEAP system you will be prompted with the account maintenance window and should change this 4 digit PIN to a new PROMISe password You are then logged into the website and can perform the available functions 2004 Pennsylvania Community Providers Association 2400 Park Drive Harrisburg PA 17110 Phone 717 657 7078 Fax 717 657 3552 www paproviders org mail paproviders org PCPA Info PROMISe Q amp A Part II March 11 2004 If you do not know what the old password PIN was you should click on the forget password link It will walk you through resetting your password This can only be done however if you are able to provide the valid provider number and SSN or FEIN information Please note that if you attempt to logon unsuccessfully for 6 times you will be locked out and will need to contact the DPW Inquiry lines who will request that your account be reset Also if you continue to experience problems or have questions regarding the registration process please refer to the Provider Internet User Manual found under the Help tab This has recently been added to the website PCPA appreciates all of the time and effort that OMHSAS and OMAP have made to provide this information 2004 Pennsylvania Community Providers Association 2400 Park Drive Harrisburg PA 17110 Phone 717 657 7078 Fax 717 657 3552 www paproviders org mail paproviders org
4. paproviders org mail paproviders org PCPA Info PROMISe Q amp A Part II March 11 2004 ISSUE The software used to create claims in the 837 HIPAA format was designed to meet the standard 835 and 837 transaction sets The vendor states that Your own organization s and state s HIPAA related requirements may likely vary from this standard Issues that could arise include Your payer may only want one claim per 837 file the vendor s standard includes several claims per 837 file RESPONSE That is correct There can be multiple claims in a batch however a payer has the option of limiting a provider to billing certain services one claim line per electronic claim This is an acceptable and permissible practice as per the HIPAA legislation ISSUE This software generates the claim file but we do not have a way of transmitting this file to DPW Do you have any suggestions for migrating to PROMISe system RESPONSE You can transmit your files to PROMISe via a bulletin board Contact the Provider Assistance Center at 1 800 248 2152 to establish a submitter ID ISSUE When we need to resubmit for services provided prior to PROMISe start up do we use the old identification numbers and procedure codes or the new PROMISe codes RESPONSE When submitting claims or eligibility requests to PROMISe you will use your 13 digit PROMISe provider numbers As local codes will be accepted until J une 30 2004 you will continue to use local
5. E Provider Type 53 is for JCAHO certified Residential Treatment Facilities and those should have converted to Provider Type 01 Specialty Code 013 Provider Type 56 is for Non CAHO Residential Treatment Facilities JCAHO RTFs will submit claims on the UB 92 Please see J CAHO RTF Billing Guide and Non CAHO RTFs will submit claims on the CMS 1500 Please see the Non CAHO RFT Billing Guide I SSUE If we have been certified 837 compliant will the PROMISe system need any additional certification RESPONSE f you were HIPAA certified for the 837 format in MAMIS there is nothing additional you will need to do No additional certification is necessary ISSUE If we enter billing via the web will we get reports indicating what has been billed RESPONSE f you submit claims via the PROMISe Internet you will not get reports However you can easily check the claim status of any claims submitted to PROMISe via the Internet claims status feature You will also see the claims on a future Remittance Advice Statement ISSUE If we use PROMISe do we have to re enter each claim each month RESPONSE Yes I SSUE How do you review claim status RESPONSE Logon to the PROMISe Internet site at http promise dpw state pa us and access Claim Status from the Claims tab on the blue bar at the top 2004 Pennsylvania Community Providers Association 2400 Park Drive Harrisburg PA 17110 Phone 717 657 7078 Fax 717 657 3552 www
6. PCPA D G March 11 2004 Pennsylvania Community Providers n Association pee Ts PROMI Se Questions and Answers Part II The questions listed below were obtained through the PROMISe conference calls PCPA coordinated with the Office of Medical Assistance Programs OMAP Office of Mental Health and Substance Abuse Services OMHSAS and EDS on February 19 The official answers to these questions are now available ISSUE How do you add a new Provider Service Location using PROMI Se RESPONSE To add a service location to your file you must use the new PROMISe Provider Enrollment Application which is available on the OMAP website http www dpw state pa us omap promise enroll omappromiseenroll asp ISSUE How are paper claims affected RESPONSE Excluding the elimination of type of service there were five blocks of the CMS 1500 which contain instructions that differ from the instructions used to submit claims to MAMIS Blocks 5 10d 19 32 and 33 I SSUE With a low volume of FFS patients would it be beneficial to set up so claims could be submitted electronically RESPONSE Absolutely there are two options providers can take advantage of with regard to electronic billing With a low volume of Fee for Service recipients the PROMISe Internet Site provides the capability of interactive electronic claim submission with instant claim status upon submission Additionally DPW provides the Provider Electronic Solu
7. PES or a private vendor Direct Line User and a toll free telephone number Please refer to the OMAP website for specific information regarding EVS and its features I SSUE Our only current questions concerns are regarding the new EVS system We run approximately 500 patients through the current EVS at least twice per week The new EVS is more time consuming since we need to re key our provider number and Provider Code for each request Is there any way the system can auto fill or save the provider number and code RESPONSE If using the Provider Electronic Solution software or the Internet there is no need to re enter the provider number However if you are using a private vendor s application they may require you to re enter your provider number I SSUE Will PROMISe ever be able to send batch files for MA eligibility RESPONSE The Provider Electronic Solution software can be used to send batch files for eligibility verification inquiries PROMISe receives those batch files to process your eligibility transactions 2004 Pennsylvania Community Providers Association 2400 Park Drive Harrisburg PA 17110 Phone 717 657 7078 Fax 717 657 3552 www paproviders org mail paproviders org PCPA Info PROMISe Q amp A Part III March 11 2004 ISSUE Is it possible to continue to do Batch EVS RESPONSE Yes as long as you submit your eligibility inquiries in the standard 270 271 HIPAA transaction format or if you are
8. all providers using PROMISe ePEAP is available at http promise dpw state pa us to update your provider file Once registered for the PROMISe Internet site you can change your addresses on line via ePEAP ePEAP cannot be used to add a service location to your file ISSUE How do access the PROMISe system RESPONSE Providers may access the PROMISe Internet site for claim status Internet claim submission ePEAP Eligibility Verifications requesting Attachment Control Numbers etc at http promise dpw state pa us You simply register the first time you access this site by entering a valid 13 digit provider number AND the associated SSN or Federal Employer s Identification Number FEIN that is on your file Please note that if these do not match during the registration process we will indicate that the provider is not found ISSUE Are managed care payers going to be required to follow the same EPSDT guidelines as the dept RESPONSE Please contact the managed care payer for clarification on their EPSDT guidelines as they can have requirements for EPSDT that differ from those used for the Fee for Service Program 2004 Pennsylvania Community Providers Association 2400 Park Drive Harrisburg PA 17110 Phone 717 657 7078 Fax 717 657 3552 www paproviders org mail paproviders org PCPA Info PROMISe Q amp A Part II March 11 2004 ISSUE Will weight of the patient be a requirement for EPSDT screens If so when
9. at would not let me adjust claims RESPONSE That is dependent on the services you are billing for If submitting claims for inpatient psychiatric facilities interim billing is permitted every 30 days The first claim of the series would be submitted with TOB 112 each subsequent claim must be submitted using TOB 117 When submitting claims using TOB 117 you must resubmit the entire stay Providers must use the last approved CRN or ICN dependant upon where the claim was processed for the first time MAMIS versus PROMISe From and through dates need to reflect the entire period of confinement and covered days must reflect all days within that stay Section 5 of the UB 92 details Interim Billing Requirements for inpatient psychiatric facilities inpatient rehabilitation facilities etc I SSUE For a rejected claim should bill the 112 type of bill and claim is CRN plus R A RESPONSE Use the same type of bill you submitted on the claim which rejected and include the CRN or ICN dependant upon the claims having processed for the first time in MAMIS or PROMISe in Form Locator 11 of the UB 92 ISSUE Will there be a fee schedule on the website for all provider types 32 48 amp 50 are not there RESPONSE MAMIS provider type 32 represented Intensive Case Management and Resource Coordination providers Since they are now reimbursed using department established fees we will add their fee information to the fee schedule on the webs
10. burg PA 17110 Phone 717 657 7078 Fax 717 657 3552 www paproviders org mail paproviders org PCPA Info PROMISe Q amp A Part III March 11 2004 ISSUE Will we receive updated software in PROMI Se format RESPONSE If you are referring to the Provider Electronic Solutions software version 3 5 must be used for claims submission and eligibility verification to PROMISe This software is available free of charge and may be downloaded from the OMAP website ISSUE Will the existing M A procedure codes be changed to the Federal CPT codes under the PROMISe system RESPONSE Local procedure codes will be used through J une 30 2004 Standardized CPT codes will be billable J uly 1 2004 I SSUE Will the new pROMISe system handle problems on billing from the MAMIS system Ex Past rejected claims that are still being processed Will these claims cross over into the new system RESPONSE Yes If claims were rejected in MAMIS providers must resubmit those claims to PROMISe using the 13 digit PROMISe provider number It is very important when claims processed for the first time in MAMIS are resubmitted to PROMISe that providers use the original rejected claim reference number CRN ISSUE We have specific questions about one of the crosswalks that we received where do we inquire about this RESPONSE Please submit an email to the following PROMISe state pa us ISSUE tried to log on to Promise On Line for E Peap info t
11. codes until J uly 1 2004 ISSUE Will PROMISe ever have the capability of including more than one service location in an 837 file For example we have 9 outpatient locations and therefore must create and maintain 9 different files Since both the claim and service loops contain facility information this might be a possibility Another option is the NTE service line type that you are currently using for service type Could not the 4 digit service location be placed here with the 9 digit provider number in Loops 1000A and 2010AA RESPONSE If the rendering provider has multiple service locations and they wish to submit charges for the same recipient who has been seen at multiple locations for service rendered the electronic claims must be set up separately by service location There is an 837 edit HIPAA edit that does not allow you to use the same legal entity as rendering provider in Loop 2310B Claim Level Rendering Provider and 2420A Service Line Level Rendering Provider I SSUE Do we use the submit date or service date to determine when we use the new local procedure code RESPONSE You will use the date of service Local procedure codes will be used until J une 30 2004 Standardized procedure codes will be used for services provided on or after J uly 1 2004 I SSUE s diag to be included in all programs now Are we to use the Diag Pointer 1 RESPONSE No please refer to you billing guide for specific instructions on when diag
12. his am and I m unable to log on using the passwords had set up I m also unable to place a new application for my providers as the return response indicates their information is already in the system Does that mean the password has been changed or does it mean that someone else has now registered these doctors under a different billing setting RESPONSE Logon Ids and passwords for the PROMISe website are obtained through a self registration process You register using the Create your user account setup now function If it indicates that you are already registered it may be because you previously used the ePEAP application and are considered already registered To facilitate initial registration any providers who were previously registered in MAMIS to use the ePEAP Internet application to update their provider files were converted in PROMISe so that they would not need to register again All old MA ID numbers and their new 13 digit numbers including multiple service locations were converted So if you had one active MA ID in MAMIS and three address codes and used one 4 digit PIN to apply provider file updates and you now have three 13 digit PROMISe provider numbers all three these new numbers have been converted to use the one 4 digit PIN To logon to the Internet application you will need to enter your 13 digit provider number in the Logon ID field and the 4 digit ePEAP PIN in the Password field After you enter a valid 13
13. ite ISSUE Do we need to submit State Match forms as attachments RESPONSE No you still need to complete the state match verification process prior to billing for Intensive Case Management Resource Coordination Family Base Mental Health or Mental Health Crisis Intervention services in PROMISe You are instructed to maintain documentation in house in case of an audit You do not submit the information to PROMISe nor do you use an Attachment Code to indicate the verification has occurred ISSUE do not see my procedure codes on the new HIPAA local codes list or on the new crosswalks how do find out what my new codes are RESPONSE The final procedure codes will be issued prior to July 1 2004 Local codes will be used until June 30 2004 Please see MA Bulletin 99 04 04 Billing of Local Codes Through PROMISe 2004 Pennsylvania Community Providers Association 2400 Park Drive Harrisburg PA 17110 Phone 717 657 7078 Fax 717 657 3552 www paproviders org mail paproviders org PCPA Info PROMISe Q amp A Part III March 11 2004 ISSUE When will behavioral health procedure codes be published by MA RESPONSE Prior to July 1 2004 as local codes will be used until J une 30 2004 See MA Bulletin 99 04 02 I SSUE If we bill through a software vendor how much information will be available in PROMI Se l e the status of an invoice RESPONSE Claim status information is available for all claims submitted regard
14. less of the submission method I SSUE Will we still need PES software for any reason RESPONSE f you choose to submit claims electronically providers can use the Provider Electronic Solutions Software or the Internet via the PROMISe Internet Site The newest version V3 5 of the Provider Electronic Solutions software is available on the web at www dpw state pa us omap hipaa PESV2 asp Also please note that V3 5 1 is soon to be released ISSUE Is PROMISe replacing EDS If not see next question assume by the reference to EDS you are referring to the Provider Electronic Solutions Software RESPONSE PROMISe is the new claims processing system that will adjudicate providers claims and generate Remittance Advice Statements EDS is the contractor selected by the Department to implement and support PROMISe The Provider Electronic Solutions software PES is a vehicle that providers can use to submit claims electronically ISSUE If we use PROMISe can we still use EDS or do we need to choose one program RESPONSE You can use the PROMISe Internet Site or PES to submit claims electronically PROMISe is the new claims processing system that will adjudicate provider claims and generate Remittance Advice Statements I SSUE EVS how will we utilize this system or what are the changes RESPONSE EVS can be accessed via the PROMISe Internet site for interactive eligibility inquiries a Bulletin Board System BBS via
15. nosis codes are required ISSUE Will providers be able to do claim adjustments electronically RESPONSE Yes 2004 Pennsylvania Community Providers Association 2400 Park Drive Harrisburg PA 17110 Phone 717 657 7078 Fax 717 657 3552 www paproviders org mail paproviders org PCPA Info PROMISe Q amp A Part III March 11 2004 I SSUE Please discuss CMS 1500 blocks 31 to 33 relating to behavioral health for new provider type 08 for psychiatric clinics General questions for new provider type 31 as well RESPONSE Block 31 must contain the signature or signature stamp of the provider rendering the service Block 32 must be left blank When completing for outpatient psychiatric clinics do not enter your provider number next to PIN in Block 33 You must enter your 13 digit PROMISe provider number next to GRP OP Psych Clinics are not permitted to have payees In most cases OP Drug and Alcohol works the same way however there could be a payee If the OP Drug and Alcohol clinic has a payee the clinic number is entered next to PIN and the payee number is entered next to GRP ISSUE If am billing an adjustment claim the first month was paid am adjusting that claim to include the second month should use the 117 type of bill and the CRN and payment line under the claim number The patient was not discharged and the following month there will be another adjusted claim There was a glitch in the original program th
16. tions free of charge This is a HIPAA compliant electronic billing software that can be downloaded free of charge from DPW s Internet site or it can be ordered from the Provider Assistance Center for a nominal shipping fee The newest version V3 5 of the Provider Electronic Solutions software is available for you on the web at www dpw state pa us omap hipaa PESV2 asp ISSUE How will PROMISe affect billing values will we be getting a new list of patient MA ID S RESPONSE Recipient numbers are not changing You will still obtain the recipient number from the recipient s Pennsylvania ACCESS Card just like you have in the past 2004 Pennsylvania Community Providers Association 2400 Park Drive Harrisburg PA 17110 Phone 717 657 7078 Fax 717 657 3552 www paproviders org mail paproviders org PCPA Info PROMISe Q amp A Part III March 11 2004 ISSUE Can funding be direct deposited RESPONSE The Department supports electronic funds transfer EFT payments The Capability to allow providers to set up direct deposit is available in PROMISe If you registered for EFT payments prior to PROMISe no re registration is necessary However if you were not registered for this please contact the Provider Assistance Center for more information on how to register ISSUE We continue to have payment rejections due to other insurance even when that insurance is no longer valid for an individual yet it continues to show up on
17. using the Provider Electronic Solutions software ISSUE We are currently HIPAA certified under MAMIS Will we be notified of PROMISe login info RESPONSE Your Bulletin Board System BBS login for MAMIS will be the same BBS login you use for PROMISe ISSUE How do we obtain logins PIN letters for the PROMI Se website RESPONSE Logon Ids and passwords for the PROMISe website are obtained through a self registration process You register using the Create your user account setup now function If it indicates that you are already registered it may be because you previously used the ePEAP application and are considered already registered If this is the case please note that in order to facilitate initial registration any providers who were previously registered in MAMIS to use the ePEAP Internet application to update their provider files were converted in PROMISe so that they would not need to register again All old MAID numbers and their new 13 digit numbers including multiple service locations were converted So if you had one active MA ID in MAMIS and three address codes and used one 4 digit PIN to apply provider file updates and you now have three 13 digit PROMISe provider numbers all three these new numbers have been converted to use the one 4 digit PIN To logon to the Internet application you will need to enter your 13 digit provider number in the Logon ID field and the 4 digit ePEAP PIN in the Password field
18. will this be implemented RESPONSE At this time the weight of the patient is not a requirement for EPSDT screens ISSUE How should immunizations for EPSDT screens be reported on the 1500 forms RESPONSE Using the procedure codes from the PA PROMISe fee schedules ISSUE What will need to be in block 10D and 24H RESPONSE If the provider is submitting a CMS 1500 for an EPSDT Screen providers must indicate the appropriate referral code if a referral was made as a result of the screen see CMS 1500 Desk Reference For any other instance Block 10d is optional If completed for something other than an EPSDT screen providers can place the Social Security Number of the primary insured in this block when the primary insured is someone other than the recipient ISSUE When will we get a list of codes new RESPONSE The Department will issue a list of new procedure codes prior to July 1 2004 as local codes will be used through J une 30 2004 MA Bulletin 99 04 04 ISSUE We currently provide BHRS or Wraparound services under our Type 50 provider number that originally was intended for our Residential Treatment services We changed our Residential Treatment provider type to 53 The personalized provider cross reference that we received noted that our Type 50 provider type would change to 56 Residential Treatment and our Type 53 provider type would change to 01 Inpatient Facility Should our Type 53 change to 56 not 01 RESPONS
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