Pa Promise Billing Guide. The providers and recipients used for these examples are fictit

The providers and recipients used for these examples are fictitious. 1. CMS 1500 ODP PA Promise is a PA. The Provider The purpose of this document is to provide a block-by-block reference guide to assist the following provider types in successfully completing the UB-04 claim form: J1l This packet contains information that will help guide ODP providers through the PROMISeTM Provider Enrollment Process. PA PROMISe™ Provider Handbook 837 Professional/CMS-1500 Claim . November 2023 Version 2. The purpose of this document is to provide a block-by-block reference guide to assist the following provider types in successfully completing the CMS-1500 claim form: This guide explains how to set up and use the MatrixCare Home Care CMS 1500 ODP PA Promise feature. 2402; and Meets all applicable requirements for MA providers as set forth in 55 Pa. 0 format. Below are links that will guide you to the The Provider Claim Inquiry window in the PROMISe™ Provider Portal is used to search claims, view original claims by ICN, and check the status of one or more claims. CMS 1500 ODP PA Promise is a new billing type based off existing billing In order for a provider to submit a claim successfully and be approved for payment, it is important that the provider understands the ODP billing process and rules surrounding it. 35 Address any comments concerning the contents of this manual to: Gainwell Technologies Attention: Documentation Unit If the YESbox is checked, Blocks 9, 9a and 9d must be completed with the information on the additional resource. See 42 CFR 405. In order for a provider to submit a claim successfully and be approved for payment, it is important that the provider understands the ODP billing This section details the various forms providers may need when billing PA PROMISeTM and the addresses, telephone numbers, and website, when available, for obtaining these forms. Regardless of CMS 1500 ODP PA Promise Billing Process This guide explains how to set up and use the MatrixCare Home Care CMS 1500 ODP PA Promise feature. Please choose the appropriate provider type or specialty Please choose the appropriate provider type or specialty below to view the PROMISe™ handbook and billing guide appropriate for you. 22 Address any comments concerning the contents of this manual to: Gainwell Technologies Attention: Documentation Unit ODP PROMISeTM Provider Enrollment Readiness Packet This packet contains information that will help guide MR providers through the PROMISeTM Provider Enrollment Process. Department of Human Services February 20, 2007 – Effective February 20, 2007, the Department issued Medical Assistance Bulletin (MAB) 26-07-01 (Clarification of Procedure Codes and Modifiers to be used when October 2025, Version 2. Providers are reminded to The Department of Human Services (DHS) offers state of the art technology through PROMISe™ — its claims processing, provider enrollment, and CMS-1500 Reference Guide for PROMISe ™ Copayment Desk Reference Rev 6/17 Healthcare Benefits Packages Reference Chart (MA PA PROMISe Provider Internet User Manual PA PROMISeTM Provider Internet User Manual Wednesday 12/31/2025 04:09 AM EST PROMISe™ Internet Portal This Companion Guide was developed to communicate the Pennsylvania Medical Assistance-specific information to process transactions in the NCPDP Version D. Some sections of these handbooks are currently under development and will be updated as additional content becomes available. Code Chapter 1101, relating to General Provisions, and 55 Pa. GOV Tuesday 12/30/2025 07:17 PM EST PROMISe™ Internet Portal INTRODUCTORY BILLING INFORMATION Billing Instructions PA Health & Wellness follows CMS rules and regulations for billing and reimbursement. Code Chapter 1129, LARC Effective with dates of service on and after December 1, 2016, the DHS will pay inpatient hospitals (Provider Type 01 and Specialty 010) for LARC (Long Acting Reversible Providers may access the PROMISe™ website for claim status, online claim submission, Provider Enrollment, Eligibility Verifications, requesting This Companion Guide was developed to communicate the Pennsylvania Medical Assistance-specific information required to successfully submit the 837 Institutional Outpatient transaction. This section of the DHS website contains PROMISe™ provider handbooks and billing guides for all provider types. CMS-1500 Billing Guide for PROMISeTM Rural Health Clinics (RHCs) & Federally Qualified Health Centers (FQHCs) Purpose of the document The purpose of this document is to provide Provider Billing and Payment In order for Office of Developmental Programs (ODP) direct service providers to receive payment for Waiver-Funded services rendered, they are required to PA PROMISeTM Provider Internet User Manual SYSTEM DOCUMENTATION LIBRARY REFERENCE NUMBER: [00000164] SECTION: 4-5B LIBRARY REFERENCE NUMBER: The Department of Human Services (DHS) offers state of the art technology through PROMISe™ — its claims processing, provider enrollment, and The CMS HIPAA Implementation Guide is the main source of information about the transaction sets. The purpose of this document is to provide a block-by-block reference guide to assist the following provider types in successfully completing the CMS-1500 claim form: Professional Medicare HMO Billing Instructions CMS-1500 Commercial Insurance Attachment (MA 538) CMS-1500 Medicare Attachment (MA In order for providers to participate with the Department of Human Services (DHS), they must first enroll. The billing guides found below are in Adobe PDF format. Use the following links to go directly to the document you would Please refer to your specific provider type billing guides in the appropriate Provider Handbook. This Companion Guide was developed to communicate the Pennsylvania Medical Assistance-specific information required to successfully submit the 837 Professional transaction.

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