Medicaid/Medical Assistance Provider Quick Tips | Department of Human Services | Commonwealth of Pennsylvania
Quick Tips for Medicaid Providers
Below are links to documents that contain helpful tips for Medicaid providers and their staff.
Tip No.
Topic
280
Version 43 of All Patient Refined-Diagnosis Related Group (APR DRG) Implementation
279
Implementation of Screening Guidelines for Prior Authorizations
278
Centers of Excellence Enrollment Tips
277
Delayed Issuance of Updated Sterilization Consent Form (MA 31)
276
Delayed Implementation of Updates to Screening Guidelines for Prior Authorizations
275
Delayed Implementation of All Patient Refined-DiagnosisRelated Group (APR DRG) Version 42
274
Ambulance Services Update
273
Benefit Limit Exception Process for Certain Dental Services Reminder
272
Delayed Implementation of All Patient Refined-Diagnosis Related Group (APR DRG) Versions 40 & 41
271
Medical Assistance Coverage of Zulresso (brexanolone) and Zurzuvae (zuranolone)
270
Revalidation of Multiple Locations
269
Incontinence Products Billing Reminder
268
Reminder for Prescribers and Providers to Request Prior Authorization for Processing Codes L1851 and L1852
267
Delayed Implementation of All Patient Refined Diagnosis Related Group (APR DRG) Version 38 & 39
266
New Group Provider Access for Reactivation/Revalidation Changes of Group Members (Fee Assigned Practitioners)
265
How to Check the Status of Your Electronic Provider Enrollment Application/Actions to Take if Your Application Was Returned for Additional Information
264
Electronic Visit Verification
263
180 Day Exception Electronic Process - Updated 6/17/25
262
Provider Enrollment Summary Enhancements
261
Important Changes are Coming for the Physical Health HealthChoices Program
260
Provider Electronic Portal Update
259
Documentation for Shift Nursing (SN) and Home Health Aide (HHA) Prior Authorization and Program Exception Requests in the Fee for Service (FFS) Delivery System
258
Provider Electronic Solutions Software
257
Medicare Sequestration Payment Reductions on All Claims Media Fee For Service (FFS) Claims Reinstated
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)
255
Provider Revalidation Requirements
254
Payment Error Rate Measurement (PERM) Initiative for RY 2025
253
Year 2020 Pennsylvania Medicaid 1099s issued by PROMISeTM
252
Medical Assistance Benefits for Beneficiaries Turning 21 During the COVID 19 Emergency
251
Medical Assistance Benefits for Beneficiaries Turning 21 During the COVID 19 Emergency
250
Version 37.1 of All Patient Refined Diagnosis Related Group (APR DRG) Implementation
249
New MA ACCESS Card
248
DexCom Continuous Glucose Monitoring Products Coverage
247
Nonemergency Ambulance Transportation Related to COVID 19
246
Rescinding Prior Guidance on Elective Services
245
All Patient Refined Diagnosis Related Group (APR DRG) to be Updated with COVID 19 Billing Codes
244
MA Eligibility During COVID 19 Emergency Disaster Declaration
243
Use of the CR Modifier and DR Condition Code for COVID 19 Disaster/Emergency Related Claims
242
Telemedicine Guidelines Related to COVID 19
241
Prior Authorization Changes in the Medical Assistance Program for Certain Services during COVID0 19 Emergency Disaster
240
Provider enrollment and revalidation changes during the COVID 19 emergency
239
Short acting beta agonist metered dose inhalers temporarily added to Statewide Preferred Drug List
238
90 Day Supplies of Medications   COVID 19
237
Teledentistry Guidelines Related to COVID 19 for Dentists, Federally Qualified Health Centers and Rural Health Clinics
236
Hydroxychloroquine Quantity Limits   COVID 19
235
Elective services should not be provided during the COVID 19 emergency disaster
234
New ICD 10 CM code or the 2019 Novel Coronavirus (COVID 19) Effective April 1, 2020
233
Waiver of Prudent Pay during COVID 19 emergency
232
Billing Guidance for Alternative Screening Sites Related to COVID 19
231
Directions to bypass the prior authorization requirements for CT Scans of the Chest for COVID 19 patients
230
COVID 19 Response: Pharmacies May Override Early Refill Alerts for Medications
229
Telemedicine Guidelines Related to COVID 19
228
ICD 10 CM Official Coding Guidelines Related to COVID 19
227
Provider Enrollment Updating Documentation Requirements
226
Version 37 of all Patient Refined Diagnosis Related Group (APR DRG) Implementation
225
The Auditor General is conducting performance audits
224
Billing for Tobacco Cessation Counseling Services provided by Pharmacists
223
Availability of the Provider Directory on the Department of Human Services Website
222
New Electronic Benefit Transfer Card
221
Common Billing Issues Which May Result in Denied Claims as of July 2019
220
Version 36 of All Patient Refined Diagnosis Related Group (APR DRG) Implementation
219
Service Location Enrollment Deadline
218
Provider Enrollment File Information Changes
217
Provider Enrollment Application Update
216
Reminder: Hospital Adverse Determination Summary Requirement
215
Payment Error Rate Measurement (PERM) Initiative for RY 2019
214
Non Emergency Ambulance Transportation
213
Professional Claims Mapping of NPI for Rendering Providers
212
Medicare and Medicare Advantage Crossover Claims for Certified Registered Nurse Practitioners (CRNP) and Physician Assistants (PA)
211
Medical Assistance (MA) Update for ASC X12N 276/277 (Claim Status Inquiry/Claim Status Response)
210
Version 35 of All Patient Refined Diagnosis Related Group (APR DRG) Implementation
209
Crossover Claims: Qualified Medicare Beneficiary (QMB) Program CARC 209 and Cost Sharing*
208
Crossover Claims: Ordering and Referring Providers
207
MA Program Fee Schedule Updates for Act 62 Procedure Codes
206
Medical Assistance Phone Options Update
205
Mid Level Practitioner: Provider Electronic Portal Update
204
IMPORTANT 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 - 2026 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 2025)
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
103
1099 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 August 2025
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 2025)
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)
Are You Puzzled by Your Remittance Advice Statement?
Long Term Living Providers
Provider Electronic Software (PES) Questions and Answers
Medicare Questions and Answers
Billing Quesitons and Answers
UB-04 Questions and Answers
General Questions and Answers