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    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 6/27/24
    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
    85Department of Human Services (DHS) Breast & Cervical Cancer Prevention & Treatment (BCCPT) Program Updated July 2024
    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
    41Medical Assistance Desk Reference Guide (Updated July 2024)
    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