What's New at OMAP | Department of Human Services | Commonwealth of Pennsylvania

What's New at OMAP | Department of Human Services | Commonwealth of Pennsylvania
​What's New at OMAP
04/23/2026
Added Managed Care Enrollment Information
Added
March 2026 HealthChoices Enrollment Report
04/15/2026
Added Remittance Advice Dates
May 2026 Remittance Advice Date
04/09/2026
Added Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Fee-for-Service Relative Weight Adjustments
04/08/2026
Added MA Bulletins numbered:
01-26-52 A Medical Assistance Bulletin entitled:
Prior Authorization Guidelines for Pediatric Adaptive Seating Equipment
03/30/2026
Added MA Bulletins numbered:
01-26-50 A Medical Assistance Bulletin entitled:
Prior Authorization Guidelines for Removable, Pre-Molded Arch Supports
01-26-51 A Medical Assistance Bulletin entitled:
Prior Authorization Guidelines for Thoracic-Lumbar-Sacral Orthoses
01-26-53 A Medical Assistance Bulletin entitled:
Prior Authorization of Sickle Cell Anemia Agents - Pharmacy Services
03/27/2026
Added Managed Care Enrollment Information
Added
February 2026 HealthChoices Enrollment Report
03/19/2026
Added MA Bulletins numbered:
08-26-50 A Medical Assistance Bulletin entitled:
Community Health Worker Enrollment in the Medical Assistance Program
03/16/2026
Added Remittance Advice Dates
April 2026 Remittance Advice Date
03/10/2026
Added Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
03/02/2026
Added MA Bulletins numbered:
01-26-49  A Medical Assistance Bulletin entitled:
Prior Authorization of GLP-1 Receptor Agonists - Pharmacy Services
02/27/2026
Added MA Bulletins numbered:
01-26-47 A Medical Assistance Bulletin entitled:
Prior Authorization Guidelines for Blood Glucose Meters with Voice Synthesizer or Integrated Lancing Blood Sample
02/26/2026
Added Managed Care Information
Added
Pennsylvania Medicaid Managed Care Directory
02/25/2026
Added Managed Care Enrollment Information
Added
January 2026 HealthChoices Enrollment Report
02/23/2026
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #280 -
Version 43 of All Patient Refined-Diagnosis Related Group (APR DRG) Implementation
02/17/2026
Added Remittance Advice Dates
March 2026 Remittance Advice Date
02/13/2026
Updated Quick Tips for Medicaid Providers
Updated Provider Quick Tip #176 -
Presumptive Eligibility for Pregnant Women - 2026 Income Limits
Added Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Date of Death Recovery
02/06/2026
Added MA Bulletins numbered
01-26-48 A Medical Assistance Bulletin entitled:
Prior Authorization Guidelines for Tracheostomy Speaking Valves and Voice Prosthetic Devices
02/04/2026
Added MA Bulletins numbered:
01-26-45 A Medical Assistance Bulletin entitled:
Prior Authorization Guidelines for Lower Extremity Orthoses
01-26-46 A Medical Assistance Bulletin entitled:
Prior Authorization Guidelines for Breast and Nipple Prostheses
01/29/2026
Added MA Bulletins numbered:
01-26-43 A Medical Assistance Bulletin entitled:
Prior Authorization Guidelines for Manual Hospital Beds and Accessories
01-26-44 A Medical Assistance Bulletin entitled:
Prior Authorization Guidelines for Face and Ear Prostheses
01/20/2026
Added Managed Care Enrollment Information
Added :
December 2025 HealthChoices Enrollment Report
Added Remittance Advice Dates
February 2026 Remittance Advice Date
01/15/2026
Added MA Bulletins numbered:
01-26-42 A Medical Assistance Bulletin entitled:
Prior Authorization Guidelines for Orthopedic Shoes and Boots and Miscellaneous Shoe Additions
12/30/2025
Added MA Bulletins numbered:
01-25-42 A Medical Assistance Bulletin entitled:
Updates to the Family Planning Services Program Fee Schedule
99-25-09 A Medical Assistance Bulletin entitled:
Updates to Limited English Proficiency Requirements
99-26-01  A Medical Assistance Bulletin entitled:
Provider Preventable Conditions PROMISe™ Provider Handbook Updates
12/23/2025
Added MA Bulletins numbered:
99-25-10 A Medical Assistance Bulletin entitled:
Pennsylvania’s Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule Update
12/22/2025
Added MA Bulletins numbered:
01-26-41 A Medical Assistance Bulletin entitled:
Revision to Prior Authorization of GLP-1 Receptor Agonists - Pharmacy Services
01-25-41 A Medical Assistance Bulletin entitled:
Prior Authorization Guidelines for Hospital Grade Breast Pumps
12/18/2025
Added
Pennsylvania Medicaid Managed Care Directory
12/17/2025
Added Managed Care Enrollment Information:
November 2025
12/12/2025
Added Remittance Advice Dates
January 2026 Remittance Advice Date
12/02/2025
Added Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
Added MA Bulletins numbered:
01-26-40 A Medical Assistance Bulletin entitled:
Statewide Preferred Drug List (PDL) Updates - Pharmacy Services
99-25-08 A Medical Assistance Bulletin entitled:
Immunization Coverage Update
11/25/2025
Added Managed Care Enrollment Information:
October 2025
11/24/2025
Added MA Bulletins numbered:
01-26-37 A Medical Assistance Bulletin entitled:
Coverage Change and Prior Authorization of GLP-1 Receptor Agonists (Formerly Hypoglycemics, Incretin Mimetics/Enhancers and Obesity Treatment Agents) - Pharmacy Services
01-26-38 A Medical Assistance Bulletin entitled:
Prior Authorization of Hypoglycemics, DPP-4 Inhibitors (Formerly Hypoglycemics, Incretin Mimetics/Enhancers) - Pharmacy Services
01-26-39 A Medical Assistance Bulletin entitled:
Coverage Change and Prior Authorization of Obesity Treatment Agents - Pharmacy Services
11/20/2025
Added MA Bulletins numbered:
09-25-43 A Medical Assistance Bulletin entitled:
Targeted Case Management Services for Eligible Juveniles Enrolled in Medical Assistance Prior to Release from a Carceral Setting
11/18/2025
Added MA Bulletins numbered:
35-25-01 A Medical Assistance Bulletin entitled:
School-Based ACCESS Program Provider Handbook
11/17/2025
Added MA Bulletins numbered:
01-26-16 A Medical Assistance Bulletin entitled:
Prior Authorization of Dry Eye Treatments - Pharmacy Services
01-26-32 A Medical Assistance Bulletin entitled:
Prior Authorization of Pulmonary Hypertension Agents, Oral and Inhaled - Pharmacy Services
11/14/2025
Added MA Bulletins numbered:
01-25-30 A Medical Assistance Bulletin entitled:
Updated Sterilization Consent Form (MA 31)
01-26-23 A Medical Assistance Bulletin entitled:
Prior Authorization of Immunomodulators, Dermatologics (formerly Immunomodulators, Atopic Dermatitis) - Pharmacy Services
01-26-24 A Medical Assistance Bulletin entitled:
Prior Authorization of Immunosuppressives, Oral - Pharmacy Services
01-26-25 A Medical Assistance Bulletin entitled:
Prior Authorization of Lipotropics, Other - Pharmacy Services
01-26-28 A Medical Assistance Bulletin entitled:
Prior Authorization of Migraine Acute Treatment Agents - Pharmacy Services
01-26-35 A Medical Assistance Bulletin entitled:
Prior Authorization of Thrombopoietics - Pharmacy Services
11/13/2025
Added Remittance Advice Dates
December 2025 Remittance Advice Date
Added MA Bulletins numbered:
99-25-07 A Medical Assistance Bulletin entitled:
Medical Assistance (MA) Program Fee Schedule Revisions
01-26-17 A Medical Assistance Bulletin entitled:
Prior Authorization of Dupixent (dupilumab) - Pharmacy Services
01-26-18 A Medical Assistance Bulletin entitled:
Prior Authorization of Epinephrine, Self-Administered (formerly Epinephrine, Self-Injected) - Pharmacy Services
01-26-19 A Medical Assistance Bulletin entitled:
Prior Authorization of Glucocorticoids, Inhaled - Pharmacy Services
01-26-20 A Medical Assistance Bulletin entitled:
Prior Authorization of Glucocorticoids, Oral - Pharmacy Services
01-26-21 A Medical Assistance Bulletin entitled:
Prior Authorization of Hepatic and Biliary Agents - Pharmacy Services
11/12/2025
Added
Pennsylvania Medicaid Managed Care Directory
Added MA Bulletins numbered:
01-26-14 A Medical Assistance Bulletin entitled:
Prior Authorization of COPD Agents - Pharmacy Services
01-26-15 A Medical Assistance Bulletin entitled:
Prior Authorization of Cytokine and CAM Antagonists - Pharmacy Services
01-26-31 A Medical Assistance Bulletin entitled:
Prior Authorization of Proton Pump Inhibitors (PPIs) - Pharmacy Services
01-26-33 A Medical Assistance Bulletin entitled:
Statewide Preferred Drug List (PDL) Updates - Pharmacy Services
01-26-34 A Medical Assistance Bulletin entitled:
Prior Authorization of Stimulants and Related Agents - Pharmacy Services
01-26-36 A Medical Assistance Bulletin entitled:
Prior Authorization of Ulcerative Colitis Agents - Pharmacy Services
11/10/2025
Added MA Bulletins numbered:
01-26-07 A Medical Assistance Bulletin entitled:
Prior Authorization of Antipsoriatics, Topical - Pharmacy Services
01-26-22 A Medical Assistance Bulletin entitled:
Prior Authorization of Hepatitis C Agents – Pharmacy Services
01-26-26 A Medical Assistance Bulletin entitled:
Prior Authorization of Lipotropics, Statins – Pharmacy Services
01-26-27 A Medical Assistance Bulletin entitled:
Prior Authorization of Lyfgenia (lovotibeglogene autotemcel) – Pharmacy Services
01-26-29 A Medical Assistance Bulletin entitled:
Prior Authorization of Multiple Sclerosis Agents – Pharmacy Services
01-26-30 A Medical Assistance Bulletin entitled:
Prior Authorization of Natalizumab – Pharmacy Services
11/07/2025
Added MA Bulletins numbered:
01-26-04 A Medical Assistance Bulletin entitled:
Prior Authorization of Antihemophilia Agents - Pharmacy Services
01-26-05 A Medical Assistance Bulletin entitled:
Prior Authorization of Monoclonal Antibodies (MABs) - Anti-IL, Anti-IgE, Anti-TSLP - Pharmacy Services
01-26-06 A Medical Assistance Bulletin entitled:
Prior Authorization of Antiparasitics, Topical - Pharmacy Services
01-26-11 A Medical Assistance Bulletin entitled:
Prior Authorization of Calcium Channel Blockers - Pharmacy Services
01-26-12 A Medical Assistance Bulletin entitled:
Prior Authorization of Casgevy (exagamglogene autotemcel) - Pharmacy Services
01-26-13 A Medical Assistance Bulletin entitled:
Prior Authorization of Continuous Glucose Monitoring Products - Pharmacy Services
11/06/2025
Added MA Bulletins numbered:
01-26-01 A Medical Assistance Bulletin entitled:
Prior Authorization of Analgesics, Acute Pain Agents - Pharmacy Services
01-26-02 A Medical Assistance Bulletin entitled:
Prior Authorization of Antibiotics, GI and Related Agents - Pharmacy Services
01-26-03 A Medical Assistance Bulletin entitled:
Prior Authorization of Antidepressants, Other - Pharmacy Services
01-26-08 A Medical Assistance Bulletin entitled:
Prior Authorization of Antipsychotics - Pharmacy Services
01-26-09 A Medical Assistance Bulletin entitled:
Prior Authorization of Bone Density Regulators - Pharmacy Services
01-26-10 A Medical Assistance Bulletin entitled:
Prior Authorization of Benign Prostatic Hyperplasia (BPH) Treatments - Pharmacy Services
10/22/2025
Added Managed Care Enrollment Information:
September 2025
10/16/2025
Added Remittance Advice Dates
November 2025 Remittance Advice Date
10/08/2025
Added Managed Care Enrollment Information:
August 2025
10/07/2025
Added MA Bulletins numbered:
27-25-42 A Medical Assistance Bulletin entitled:
Adoption of the American Academy of Pediatric Dentistry's Dental Periodicity Schedule
09/29/2025
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Community Support Service Providers - Federal Financial Participation Rate Change and Continued Billing Requirements
09/23/2025
Added Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Date of Death Recovery
09/19/2025
Added Provider Quick Tip
The following Quick Tip has been added to the website.
Added #279 -
Implementation of Screening Guidelines for Prior Authorizations
Added #278 -
Centers of Excellence Enrollment Tips
Added MA Bulletins numbered:
01-25-39 A Medical Assistance Bulletin entitled:
Prior Authorization Guidelines for Wearable Air Conduction Hearing Aids
09-25-41 A Medical Assistance Bulletin entitled:
Prior Authorization Guidelines for Enteral Nutrition
09/16/2025
Added Provider Quick Tip
The following Quick Tip has been added to the website.
Updated #277 -
Delayed Issuance of Updated Sterilization Consent Form (MA 31)
09/15/2025
Added Remittance Advice Dates
October 2025 Remittance Advice Date
09/11/2025
Added MA Bulletins numbered:
27-25-41 A Medical Assistance Bulletin entitled:
2025 Medical Assistance Program Dental Fee Schedule Update
09/10/2025
Added Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Implementation of ADA Claim Form Version 2024
09/08/2025
Updated Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
ACTION NEEDED TO CONTINUE SUBMITTING CLAIMS AND ELIGIBILITY REQUESTS ELECTRONICALLY AND RECEIVING EDI TRANSACTION RESPONSES WITH PROMISE™
09/03/2025
Added Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
08/29/2025
Added MA Bulletins numbered:
05-25-03 A Medical Assistance Bulletin entitled:
Electronic Visit Verification Manual Edits Noncompliance in the Fee-for-Service Delivery and Managed Care Delivery Systems
08/28/2025
Added
Pennsylvania Medicaid Managed Care Directory
Added Managed Care Enrollment Information:
July 2025
08/21/2025
Added Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
ACTION NEEDED TO CONTINUE SUBMITTING CLAIMS AND ELIGIBILITY REQUESTS ELECTRONICALLY AND RECEIVING EDI TRANSACTION RESPONSES WITH PROMISE™
08/13/2025
Added Remittance Advice Dates
September 2025 Remittance Advice Date
08/01/2025
Updated Provider Quick Tip
The following Quick Tip has been added to the website.
Updated #85 -
Department of Human Services (DHS) Breast & Cervical Cancer Prevention & Treatment (BCCPT) Program
Updated August 2025
07/31/2025
Added Provider Quick Tip
The following Quick Tip has been added to the website.
Added #276 -
Delayed Implementation of Updates to Screening Guidelines for Prior Authorizations
07/25/2025
Added Managed Care Enrollment Information:
June 2025
07/15/2025
Added Remittance Advice Dates
August 2025 Remittance Advice Date
07/11/2025
Added Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Fee-for-Service (FFS) Relative Weight Adjustments
07/09/2025
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #275 -
Delayed Implementation of All Patient Refined-Diagnosis Related Group (APR DRG) Version 42
06/30/2025
Added
Pennsylvania Medicaid Managed Care Directory
Added Managed Care Enrollment Information:
May 2025
06/25/2025
Added MA Bulletins numbered:
08-25-40 A Medical Assistance Bulletin entitled:
Implementation of Updated Dental Benefit Limit Exception Form
06/24/2025
Added MA Bulletins numbered:
99-25-03 A Medical Assistance Bulletin entitled:
Updates to Screening Guidelines for Prior Authorization
06/23/2025
Added MA Bulletins numbered:
99-25-06 A Medical Assistance Bulletin entitled:
2025 Healthcare Common Procedure Coding System (HCPCS) Updates, Fee Adjustments, and Other Procedure Code Changes
06/17/2025
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #263 -
180 Day Exception Electronic Process - Updated 6/17/25
06/12/2025
Added MA Bulletins numbered:
01-25-38 A Medical Assistance Bulletin entitled:
Statewide Preferred Drug List (PDL) Updates - Pharmacy Services
06/11/2025
Added Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
06/10/2025
Added Remittance Advice Dates –
July 2025 Remittance Advice Date
06/09/2025
Added Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
ACTION NEEDED TO CONTINUE SUBMITTING CLAIMS AND ELIGIBILITY REQUESTS ELECTRONICALLY AND RECEIVING EDI TRANSACTION RESPONSES WITH PROMISE™
06/04/2025
Added Managed Care Enrollment Information:
April 2025
05/21/2025
Added MA Bulletins numbered:
99-25-05 A Medical Assistance Bulletin entitled:
Pennsylvania’s Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
05/15/2025
Added MA Bulletins numbered:
99-25-04 A Medical Assistance Bulletin entitled:
2025 Recommended Child and Adolescent Immunization Schedule
Added Remittance Advice Dates –
June 2025 Remittance Advice Date
05/13/2025
Added MA Bulletins numbered:
17-25-01 A Medical Assistance Bulletin entitled:
Implementation of ADA Claim Form - Version 2024
05/05/2025
Updated Provider Quick Tip #207 -
MA Program Fee Schedule Updates for Act 62 Procedure Codes
04/30/2025
Added
Pennsylvania Medicaid Managed Care Directory
04/28/2025
Added Managed Care Enrollment Information:
March 2025
04/17/2025
Added Remittance Advice Dates –
May 2025 Remittance Advice Date
04/16/2025
Added MA Bulletins numbered:
99-25-02 A Medical Assistance Bulletin entitled:
Medical Assistance (MA) Program  Fee Schedule Revisions
08-25-35 A Medical Assistance Bulletin entitled:
Federally Qualified Health Center and Rural Health Clinic Procedure Codes
04/10/2025
Added Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Newborn MA 112 Form Completion and Submission
04/08/2025
Added MA Bulletins numbered:
09-25-35 A Medical Assistance Bulletin entitled:
Application of Topical Fluoride Varnish
04/03/2025
Added Remittance Advice Alerts
The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Date of Death Recovery
Added MA Bulletins numbered:
08-25-01 A Medical Assistance Bulletin entitled:
Federally Qualified Health Center and Rural Health Clinic Alternative Payment Methodology for Long-Acting Reversible Contraceptives
03/25/2025
Added Managed Care Enrollment Information:
February 2025
03/19/2025
Added
Pennsylvania Medicaid Managed Care Directory
03/18/2025
Added Remittance Advice Dates –
April 2025 Remittance Advice Date
03/12/2025
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
02/27/2025
Updated Provider Quick Tip #121 -
Certification Renewal Required for Medical Assistance (MA) Providers Dispensing Hearing Aid Supplies (revised February 2025)
Updated Provider Quick Tip #176 -
Presumptive Eligibility for Pregnant Women - 2025 Income Limits
Added
Pennsylvania Medicaid Managed Care Directory
Added Managed Care Enrollment Information:
January 2025
02/18/2025
Added MA Bulletins numbered:
01-25-34 A Medical Assistance Bulletin entitled:
Screening, Diagnostic, and Targeted Case Management Services for Eligible Juveniles Enrolled in Medical Assistance Prior to Release from a Carceral Setting
Added Remittance Advice Dates –
March 2025 Remittance Advice Date
01/28/2025
Added PROMISe Provider Handbooks and Billing Guides Information:
Updated
837 Professional / CMS-1500 Claim Form
01/22/2025
Added Remittance Advice Dates –
February 2025 Remittance Advice Date
01/21/2025
Added Managed Care Enrollment Information:
December 2024
01/16/2025
Added MA Bulletins numbered:
99-25-01 A Medical Assistance Bulletin entitled:
Limited English Proficiency Requirements
01/10/2025
Added MA Bulletins numbered:
01-25-33 A Medical Assistance Bulletin entitled:
Prior Authorization of Anticonvulsants - Pharmacy Services
03-25-33 A Medical Assistance Bulletin entitled:
Update to the Admissions Notice Packet (MA 401)
01/02/2025
Added Managed Care Enrollment Information:
November 2024
12/23/2024
09-25-33 A Medical Assistance Bulletin entitled:
Coverage of and Payment for Doula Services in the Medical Assistance Program
12/20/2024
Added Remittance Advice Dates –
January 2025 Remittance Advice Date
12/18/2024
Updated
Pennsylvania Medicaid Managed Care Directory
12/06/2024
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
12/04/2024
Added Managed Care Enrollment Information:
October 2024
11/21/2024
Added Remittance Advice Dates –
December 2024 Remittance Advice Date
11/19/2024
99-24-09 A Medical Assistance Bulletin entitled
Medical Assistance Program Vaccine Desk Reference Updates
11/14/2024
Added MA Bulletins numbered:
01-25-31 A Medical Assistance Bulletin entitled
Prior Authorization of Thrombopoietics - Pharmacy Services
01-25-32 A Medical Assistance Bulletin entitled
Prior Authorization of Ulcerative Colitis Agents - Pharmacy Services
11/13/2024
Added MA Bulletins numbered:
01-25-25 A Medical Assistance Bulletin entitled
Prior Authorization of Phosphate Lowering Agents (Formerly Phosphate Binders) - Pharmacy Services
01-25-26 A Medical Assistance Bulletin entitled
Prior Authorization of Pulmonary Hypertension Agents, Oral and Inhaled - Pharmacy Services
01-25-27 A Medical Assistance Bulletin entitled
Prior Authorization of Skeletal Muscle Relaxants - Pharmacy Services
01 25-28 A Medical Assistance Bulletin entitled
Statewide Preferred Drug List (PDL) Updates - Pharmacy Services
01-25-29 A Medical Assistance Bulletin entitled
Prior Authorization of Stimulants and Related Agents - Pharmacy Services
01-25-30 A Medical Assistance Bulletin entitled
Prior Authorization of Thalidomide and Derivatives - Pharmacy Services
11/12/2024
Added MA Bulletins numbered:
01-25-12 A Medical Assistance Bulletin entitled
Prior Authorization of Colony Stimulating Factors - Pharmacy Services
01-25-16 A Medical Assistance Bulletin entitled
Prior Authorization of Immunomodulators, Atopic Dermatitis - Pharmacy Services
01-25-17 A Medical Assistance Bulletin entitled
Prior Authorization of Lipotropics, Other - Pharmacy Services
01-25-21 A Medical Assistance Bulletin entitled
Prior Authorization of Natalizumab - Pharmacy Services
01-25-23 A Medical Assistance Bulletin entitled
Prior Authorization of Oncology Agents, Oral - Pharmacy Services
01-25-24 A Medical Assistance Bulletin entitled
Prior Authorization of Pancreatic Enzymes - Pharmacy Services
11/08/2024
Added MA Bulletins numbered:
01-25-11 A Medical Assistance Bulletin entitled
Prior Authorization of Botulinum Toxins - Pharmacy Services
01-25-10 A Medical Assistance Bulletin entitled
Prior Authorization of Antipsychotics - Pharmacy Services
01-25-09 A Medical Assistance Bulletin entitled
Prior Authorization of Antiparkinson’s Agents - Pharmacy Services
01-25-08 A Medical Assistance Bulletin entitled
Prior Authorization of Monoclonal Antibodies (MABs) – Anti-IL, Anti-IgE, Anti-TSLP - Pharmacy Services
01-25-07 A Medical Assistance Bulletin entitled
Prior Authorization of Antifibrotic Respiratory Agents - Pharmacy Services
01-25-04 A Medical Assistance Bulletin entitled
Prior Authorization of Anticonvulsants - Pharmacy Services
11/07/2024
Added MA Bullletins:
01-25-03 Medical Assistance Bulletin entitled
Prior Authorization of Analgesics, Opioid Short-Acting – Pharmacy Services
01-25-02 Medical Assistance Bulletin entitled
Prior Authorization of Analgesics, Opioid Long-Acting – Pharmacy Services
01-25-01 Medical Assistance Bulletin entitled
Prior Authorization of Analgesics, Non-Opioid Barbiturate Combinations – Pharmacy Services
Added MA Bulletins numbered:
01-25-05 A Medical Assistance Bulletin entitled
Prior Authorization of Antidepressants, Other - Pharmacy Services
01-25-06 A Medical Assistance Bulletin entitled
Prior Authorization of Antidepressants, SSRIs - Pharmacy Services
01-25-22 A Medical Assistance Bulletin entitled
Prior Authorization of Neuropathic Pain Agents - Pharmacy Services
11/06/2024
Added MA Bulletins numbered:
01-25-13 A Medical Assistance Bulletin entitled
Prior Authorization of Cytokine and CAM Antagonists - Pharmacy Services
01-25-14 A Medical Assistance Bulletin entitled
Prior Authorization of Hepatic and Biliary Agents (formerly Bile Salts) - Pharmacy Services
01-25-15 A Medical Assistance Bulletin entitled
Prior Authorization of Hereditary Angioedema (HAE) Agents - Pharmacy Services
01-25-18 A Medical Assistance Bulletin entitled
Prior Authorization of Migraine Acute Treatment Agents - Pharmacy Services
01-25-19 A Medical Assistance Bulletin entitled
Prior Authorization of Migraine Prevention Agents - Pharmacy Services
01-25-20 A Medical Assistance Bulletin entitled
Prior Authorization of Multiple Sclerosis Agents - Pharmacy Services
11/04/2024
Updated
Pennsylvania Medicaid Managed Care Directory
11/01/2024
Added MA Bulletins numbered:
08-24-16 A Medical Assistance Bulletin entitled
Updates to The PROMISe™ Provider Handbook 837 Professional/CMS-1500 Claim Form, Appendix E – FQHC/RHC Handbook
10/29/2024
Added MA Bulletins numbered:
99-24-08 A Medical Assistance Bulletin entitled
Pennsylvania’s Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
10/24/2024
Added Managed Care Enrollment Information:
September 2024
10/18/2024
Added Remittance Advice Dates –
November 2024 Remittance Advice Date
10/16/2024
Added MA Bulletins numbered:
08-24-15 A Medical Assistance Bulletin entitled
Federally Qualified Health Center and Rural Health Clinic Payment for SARS-CoV-2 Vaccine Administration
09/25/2024
Added Managed Care Enrollment Information:
August 2024
09/19/2024
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
09/17/2024
Added Remittance Advice Dates –
October 2024 Remittance Advice Date
09/16/2024
Added MA Bulletins numbered:
99-24-06 A Medical Assistance Bulletin entitled
MA Program Fee Schedule Updates for Certain Ophthalmology Procedure Codes
35-24-01 A Medical Assistance Bulletin entitled
School-Based ACCESS Program Provider Handbook
09/09/2024
Added MA Bulletins numbered:
99-24-07 A Medical Assistance Bulletin entitled
Medical Assistance (MA) Program Fee Schedule Revisions
01-24-13 A Medical Assistance Bulletin entitled
MA Program Fee Schedule Updates For Certain Family Planning Procedure Codes
09/06/2024
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Community Support Service Providers - Federal Financial Participation Rate Change and Continued Billing Requirements
09/04/2024
Updated
Pennsylvania Medicaid Managed Care Directory
08/26/2024
Added Managed Care Enrollment Information:
July 2024
08/23/2024
Added MA Bulletins numbered:
05-24-01 A Medical Assistance Bulletin entitled
Updated Electronic Visit Verification Manual Edits Compliance Percentage Requirements in the Fee-for-Service Delivery and Managed Care Delivery Systems
08/20/2024
Added Remittance Advice Dates –
September 2024 Remittance Advice Date
08/7/2024
Added MA Bulletins numbered
:
01-24-11 A Medical Assistance Bulletin entitled
Prior Authorization of Hypoglycemics, Incretin Mimetics/Enhancers – Pharmacy Services
01-24-12 A Medical Assistance Bulletin entitled
Prior Authorization of Obesity Treatment Agents – Pharmacy Service
07/31/2024
Added Managed Care Enrollment Information:
June 2024
Updated Provider Quick Tip #41 -
Medical Assistance Desk Reference Updated July 2024
07/25/2024
Updated Provider Quick Tip #85 -
Department of Human Services (DHS) Breast & Cervical Cancer Prevention & Treatment (BCCPT) Program Updated July 2024
07/17/2024
Added Remittance Advice Dates –
August 2024 Remittance Advice Date
07/08/2024
Added MA Bulletins numbered:
99-24-05 A Medical Assistance Bulletin entitled - Ophthalmology Fee Updates
07/02/2024
Added MA Bulletins numbered:
01-24-07 A Medical Assistance Bulletin entitled - Prior Authorization of Lyfgenia (lovotibeglogene autotemcel) – Pharmacy Services
01-24-08 A Medical Assistance Bulletin entitled - Prior Authorization of Zynteglo (betibeglogene autotemcel) – Pharmacy Services
01-24-09 A Medical Assistance Bulletin entitled - Prior Authorization of Antidepressants, Other – Pharmacy Services
01-24-10 A Medical Assistance Bulletin entitled - Prior Authorization of Casgevy (exagamglogene autotemcel) – Pharmacy Services
06/28/2024
Added Managed Care Enrollment Information:
May 2024
Updated
Pennsylvania Medicaid Managed Care Directory
06/26/2024
·Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Changes to Electronic Funds Transfer (EFT) Procedure
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #263 - 180 Day Exception Electronic Process - Updated 6/27/24
06/21/2024
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Date of Death Recovery
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
06/20/2024
Added Remittance Advice Dates –
July 2024 Remittance Advice Date
06/05/2024
Added MA Bulletins numbered: 27-24-03 A Medical Assistance Bulletin entitled -
2024 Medical Assistance Program Dental Fee Schedule Update
06/03/2024
Updated Provider Quick Tip #207 -
MA Program Fee Schedule Updates for Act 62 Procedure Codes
05/28/2024
Added MA Bulletins numbered:
99-24-03 A Medical Assistance Bulletin entitled -
2024 Healthcare Common Procedure Coding System (HCPCS) Updates, Fee Adjustments, and Other Procedure Code Changes
01-24-06 A Medical Assistance Bulletin entitled -
Updates to the Family Planning Services Program Fee Schedule
05/22/2024
Added Provider Quick Tips — The following Quick Tips have been added to the website
#274 —
Ambulance Services Update
05/21/2024
Added Remittance Advice Dates –
June 2024 Remittance Advice Date
Added Managed Care Enrollment Information:
April 2024
05/10/2024
Updated Provider Quick Tips - The following Quick Tips have been added to the website.
#176 -
Presumptive Eligibility for Pregnant Women - 2024 Income Limits
05/03/2024
Added Technology Assessment Group information to the website.
Technology Assessment Group
05/01/2024
Added Managed Care Enrollment Information:
March 2024
Updated
Pennsylvania Medicaid Managed Care Directory
04/29/2024
Added MA Bulletin numbered:
99-24-02 A Medical Assistance Bulletin entitled
Medical Assistance (MA) Program Fee Schedule Revisions
04/18/2024
Added MA Bulletin numbered:
26-24-01 A Medical Assistance Bulletin entitled
Ambulance Services
04/16/2024
Added MA Bulletins numbered: 99-24-04 A Medical Assistance Bulletin entitled
2024 Recommended Child and Adolescent Immunization Schedule
Added Remittance Advice Dates –
May 2024 Remittance Advice Date
04/10/2024
Added MA Bulletin numbered:
01-24-04 A Medical Assistance Bulletin entitled
Over-the-Counter Oral Contraceptives
04/05/2024
Added Provider Quick Tip — The following Quick Tip has been added to the website.
Added #273 - Benefit Limit Exception Process for Certain Dental Services Reminder
03/25/2024
Added Provider Quick Tip — The following Quick Tip has been added to the website.
Added #272 - Delayed Implementation of All Patient Refined-Diagnosis Related Group (APR DRG) Versions 40 & 41
03/21/2024
Added Managed Care Enrollment Information:
Added February 2024
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
03/20/2024
Added Remittance Advice Dates –
April  2024 Remittance Advice Date
03/05/2024
Added Managed Care Enrollment Information: Added
January 2024
03/04/2024
Added Remittance Advice Dates -
March 2024 Remittance Advice Date
03/1/2024
Added MA Bulletins numbered:
08-24-04 A Medical Assistance Bulletin entitled
Updates to The PROMISe™ Provider Handbook837 Professional/CMS-1500 Claim Form,Appendix E – FQHC/RHC Handbook
02/14/2024
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Date of Death Recovery
Pharmacist Enrollment in Medical Assistance Program
02/13/2024
Added MA Bulletins numbered:
01-24-01 A Medical Assistance Bulletin entitled
Pharmacist Billing
02/06/2024
Added MA Bulletins numbered:
01-24-03 A Medical Assistance Bulletin entitled
Prior Authorization of Opioid Use Disorder Treatments – Pharmacy Services
02/01/2024
Added MA Bulletins numbered:
10-24-02 A Medical Assistance Bulletin entitled
Pharmacist Enrollment in the Medical Assistance Program
01/24/2024
Added MA Bulletins numbered:
99-24-01 A Medical Assistance Bulletin entitled
Medical Assistance Program Vaccine Desk Reference
01/22/2024
Added Managed Care Enrollment Information:
Added
December 2023
01/19/2024
Added MA Bulletins numbered:
01-24-02 A Medical Assistance Bulletin entitled
Pasteurized Donor Human Milk Coverage Updates
01/12/2024
Added Remittance Advice Dates -
February 2024 Remittance Advice Date
Added Updated
Pennsylvania Medicaid Managed Care Directory
01/10/2024
Added MA Bulletins numbered:
13-24-01 A Medical Assistance Bulletin entitled
Doula Enrollment in the Medical Assistance Program
Coverage of and Payment for Doula Services in the
Medical Assistance Program
12/29/2023
Added Updated
Pennsylvania Medicaid Managed Care Directory
12/28/2023
Added MA Bulletins numbered:
99-23-10 A Medical Assistance Bulletin entitled
Payment for Services Associated with Qualifying Clinical Trials
12/27/2023
Added MA Bulletins numbered:
08-24-01 A Medical Assistance Bulletin entitled
Interprofessional Consultation Services
Added Managed Care Enrollment Information:
Added
November 2023
12/21/2023
Added MA Bulletins numbered:
01-23-56 A Medical Assistance Bulletin entitled
Prior Authorization of Hypoglycemics, Incretin Mimetics/Enhancers – Pharmacy Services
12/20/2023
Added MA Bulletins numbered:
99-23-12 A Medical Assistance Bulletin entitled
Ex Parte Retroactive Reinstatement of Coverage
99-23-11 A Medical Assistance Bulletin entitled
Carr v. Becerra - Retroactive Reinstatement of Coverage
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
EVV Communication Alert for HHCS
12/15/2023
Added Remittance Advice Dates -
January 2024 Remittance Advice Date
12/13/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
12/12/2023
Added Managed Care Enrollment Information:
Added
October 2023
12/11/2023
Added MA Bulletins numbered:
01-23-27 A Medical Assistance Bulletin entitled
MA Program Fee Schedule Updates for the Administration of SARS-CoV-2 Vaccines
12/08/2023
Added Updated
Pennsylvania Medicaid Managed Care Directory
11/27/2023
Added MA Bulletins numbered:
01-23-47 A Medical Assistance Bulletin entitled
Prior Authorization of Multiple Sclerosis Agents - Pharmacy Services
01-23-54 A Medical Assistance Bulletin entitled
Prior Authorization of Ulcerative Colitis Agents - Pharmacy Services
11/16/2023
Added Remittance Advice Dates -
December 2023 Remittance Advice Dates
11/14/2023
Added MA Bulletins numbered:
01-23-49 A Medical Assistance Bulletin entitled
Prior Authorization of Obesity Treatment Agents - Pharmacy Services
01-23-52 A Medical Assistance Bulletin entitled
Statewide Preferred Drug List (PDL) Updates - Pharmacy Services
11/13/2023
Added MA Bulletins numbered:
01-23-29 A Medical Assistance Bulletin entitled
Prior Authorization of Antibiotics, GI and Related Agents - Pharmacy Services
01-23-32 A Medical Assistance Bulletin entitled
Prior Authorization of Antipsychotics - Pharmacy Services
01-23-35 A Medical Assistance Bulletin entitled
Prior Authorization of Bone Density Regulators - Pharmacy Services
01-23-39 A Medical Assistance Bulletin entitled
Prior Authorization of Estrogens - Pharmacy Services
01-23-42 A Medical Assistance Bulletin entitled
Prior Authorization of Hypoglycemics, Incretin Mimetics/Enhancers - Pharmacy Services
Added Updated
Pennsylvania Medicaid Managed Care Directory
11/09/2023
Added MA Bulletins numbered:
01-23-46 A Medical Assistance Bulletin entitled
Prior Authorization of Migraine Prevention Agents – Pharmacy Services
01-23-48 A Medical Assistance Bulletin entitled
Prior Authorization of Natalizumab [formerly Tysabri (natalizumab)] – Pharmacy Services
01-23-50 A Medical Assistance Bulletin entitled
Prior Authorization of Pituitary Suppressive Agents, LHRH – Pharmacy Services
01-23-51 A Medical Assistance Bulletin entitled
Prior Authorization of Sedative Hypnotics – Pharmacy Services
01-23-53 A Medical Assistance Bulletin entitled
Prior Authorization of Tubeless Insulin Delivery Devices – Pharmacy Services
11/08/2023
Added MA Bulletins numbered:
01-23-30 A Medical Assistance Bulletin entitled
Prior Authorization of Antidepressants, Other - Pharmacy Services
01-23-34 A Medical Assistance Bulletin entitled
Prior Authorization of Anxiolytics - Pharmacy Services
01-23-43 A Medical Assistance Bulletin entitled
Prior Authorization of Immunomodulators, Atopic Dermatitis – Pharmacy Services
01-23-44 A Medical Assistance Bulletin entitled
Prior Authorization of Lipotropics, Other - Pharmacy Services
01-23-45 A Medical Assistance Bulletin entitled
Prior Authorization of Macular Degeneration Agents - Pharmacy Services
11/07/2023
Added MA Bulletins numbered:
01-23-28 A Medical Assistance Bulletin entitled
Prior Authorization of Androgenic Agents - Pharmacy Services
01-23-31 A Medical Assistance Bulletin entitled
Prior Authorization of Antihemophilia Agents - Pharmacy Services
01-23-38 A Medical Assistance Bulletin entitled
Prior Authorization of Dupixent (dupilumab) - Pharmacy Services
01-23-40 A Medical Assistance Bulletin entitled
Prior Authorization of Hereditary Angioedema (HAE) Agents - Pharmacy Services
01-23-41 A Medical Assistance Bulletin entitled
Prior Authorization of Hepatitis C Agents - Pharmacy Services
Added the updated
Pennsylvania Medicaid Managed Care Directory
11/06/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
HHCS EVV HARD LAUNCH REMINDER
Added MA Bulletins numbered:
01-23-33 A Medical Assistance Bulletin entitled
Prior Authorization of Antivirals, CMV - Pharmacy Services
01-23-36 A Medical Assistance Bulletin entitled
Prior Authorization of Continuous Glucose Monitoring Products - Pharmacy Services
01-23-37 A Medical Assistance Bulletin entitled
Prior Authorization of Cytokine and CAM Antagonists - Pharmacy Services
11/03/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Date of Death Recovery
11/02/2023
Added MA Bulletins numbered:
24-23-23 A Medical Assistance Bulletin entitled
Addition of a Procedure Code for Sexually Transmitted Infection Test Kits
10/30/2023
Added Managed Care Enrollment Information:
Added
September 2023
10/23/2023
Added MA Bulletins numbered:
01-23-24 A Medical Assistance Bulletin entitled
2023 Medical Assistance Program Dental Fee Schedule Update and Dental Provider Handbook Update
10/17/2023
Added Remittance Advice Dates -
November 2023 Remittance Advice Dates
10/11/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
PROMISe Maintenance October 20th – 22nd
10/05/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
New Quick Tip for Group and Individual Providers
Revisions to Participating Drug Company List for Medicaid Drug Rebate Program
10/03/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #270 -
Revalidation of Multiple Locations
10/02/2023
Added Managed Care Enrollment Information:
Added
August 2023
09/29/2023
Added MA Bulletins numbered:
01-23-25 A Medical Assistance Bulletin entitled
Addition of Procedure Codes for Vaccine Administration
01-23-26 A Medical Assistance Bulletin entitled
Street Medicine
09/28/2023
Added MA Bulletin numbered:
27-23-15 A Medical Assistance Bulletin entitled
2023 Pediatric Dental Periodicity Schedule Updates
09/20/2023
Added MA Bulletin numbered:
05-23-08 A Medical Assistance Bulletin entitled
Update to Electronic Visit Verification Requirements for Pediatric Home Health Aide Services in the Fee-or-Service and Managed Care Delivery Systems
09/18/2023
Added Remittance Advice Dates -
October 2023 Remittance Advice Dates
09/13/2023
Added MA Bulletin numbered:
01-23-23 A Medical Assistance Bulletin entitled
2023 Updates to Childhood Nutrition and Weight Management Services
09/11/2023
Added MA Bulletin numbered:
05-23-06 A Medical Assistance Bulletin entitled
Pediatric Shift Care Services for Beneficiaries Under 21 Years of Age
09/08/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #269 -
Incontinence Products Billing Reminder
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Community Support Service Providers - Federal Financial Participation Rate Change and Continued Billing Requirements
09/06/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #207 -
MA Program Fee Schedule Updates for Act 62 Procedure Codes
09/01/2023
Added MA Bulletin numbered:
01-23-22 A Medical Assistance Bulletin entitled
Updates to the Family Planning Services Program Fee Schedule
08/31/2023
Added MA Bulletin numbered:
99-23-09 A Medical Assistance Bulletin entitled
2023 Healthcare Common Procedure Coding System (HCPCS) Updates, Fee Adjustments, and Other Procedure Code Changes
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #268 -
Reminder for Prescribers and Providers to Request Prior Authorization for Processing Codes L1851 and L1852
08/28/2023
Added the updated
Pennsylvania Medicaid Managed Care Directory
08/22/2023
Added Remittance Advice Dates -
September 2023 Remittance Advice Dates
08/17/2023
Added Managed Care Enrollment Information:
Added
July 2023
08/07/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #263 -
180 Day Exception Electronic Process - Updated 08/01/2023
08/02/2023
Added MA Bulletin numbered:
99-23-08 A Medical Assistance Bulletin entitled
Updates to Guidelines for the Delivery of Physical Health Services via Telehealth
07/31/2023
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #85 -
Department of Human Services (DHS) Breast & Cervical Cancer Prevention & Treatment (BCCPT) Program Updated July 2023
07/26/2023
Added MA Bulletin numbered:
01-23-21 A Medical Assistance Bulletin entitled
Updated Sterilization Consent Form (MA 31)
07/21/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #263 -
180 Day Exception Electronic Process - Updated 07/21/2023
07/20/2023
Added Managed Care Enrollment Information:
Added
June 2023
07/17/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #263 -
180 Day Electronic Process - Updated 07/14/2023
07/14/2023
Added Remittance Advice Dates -
August 2023 Remittance Advice Dates
07/05/2023
Added MA Bulletin numbered:
08-23-12 A Medical Assistance Bulletin entitled
Street Medicine
07/03/2023
Added Provider Quick Tips - The following Quick Tip has been added to the website.
Added #267 -
Delayed Implementation of All Patient Refined-Diagnosis Related Group (APR DRG) Version 38 & 39
06/30/2023
Added MA Bulletin numbered:
01-23-14 A Medical Assistance Bulletin entitled
Clinical Prior Authorization of Non-PDL Drugs – Pharmacy Services
01-23-18 A Medical Assistance Bulletin entitled
Prior Authorization of Opioid Use Disorder Treatments - Pharmacy Services
01-23-19 A Medical Assistance Bulletin entitled
Prior Authorization of Progestational Agents - Pharmacy Services
01-23-20 A Medical Assistance Bulletin entitled
Prior Authorization of Tepezza (teprotumumab-trbw) - Pharmacy Services
Added the updated
Pennsylvania Medicaid Managed Care Directory
06/29/2023
Added MA Bulletin numbered:
01-23-17 A Medical Assistance Bulletin entitled
Prior Authorization of Hepatitis C Agents - Pharmacy Services
01-23-16 A Medical Assistance Bulletin entitled
Prior Authorization of Cough and Cold Medications - Pharmacy Services
01-23-15 A Medical Assistance Bulletin entitled
Prior Authorization of Compounded Prescriptions - Pharmacy Services
01-23-13 A Medical Assistance Bulletin entitled
Prior Authorization of Antiparasitics, Topical - Pharmacy Services
01-23-12 A Medical Assistance Bulletin entitled
Prior Authorization of Antiemetic/Antivertigo Agents - Pharmacy Services
06/28/2023
Added MA Bulletin numbered:
01-23-09 A Medical Assistance Bulletin entitled
Prior Authorization of Amyloid-Targeted Monoclonal Antibodies (MABs) - Pharmacy Services
01-23-10 A Medical Assistance Bulletin entitled
Prior Authorization of Analgesics, Opioid Long-Acting - Pharmacy Services
01-23-11 A Medical Assistance Bulletin entitled
Prior Authorization of Analgesics, Opioid Short-Acting - Pharmacy Services
06/27/2023
Added MA Bulletin numbered:
99-23-07 A Medical Assistance Bulletin entitled
Pennsylvania’s Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
Added Managed Care Enrollment Information:
Added
April 2023
and
May 2023
06/22/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
APR DRG v38 & 39 Update
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
06/21/2023
Added Remittance Advice Dates -
July 2023 Remittance Advice Dates
06/20/2023
Added MA Bulletin numbered:
01-23-08 A Medical Assistance Bulletin entitled
MA Program Fee Schedule Update for an Additional Bivalent Dose of the SARS-CoV-2 Vaccine Manufactured by Pfizer, Inc.
06/16/2023
Added MA Bulletin numbered:
99-23-05 A Medical Assistance Bulletin entitled
Updates for the Enrollment or Revalidation of Co-Located Providers
06/01/2023
Updated Provider Quick Tips - The following Quick Tips have been updated to the website.
Updated #254 -
Payment Error Rate Measurement (PERM) Initiative for RY 2025
Added MA Bulletin numbered:
99-23-06 A Medical Assistance Bulletin entitled
2023 Evaluation and Management Fee Adjustments and Code Updates
05/30/2023
Added MA Bulletin numbered:
01-23-05 A Medical Assistance Bulletin entitled
End-Dating COVID-19 Pharmacy Specimen Collection and Laboratory Testing Procedure Codes
01-23-06 A Medical Assistance Bulletin entitled
Billing Updates for Vaccine Counseling Only Visits for Beneficiaries Under the Age of 21
01-23-07 A Medical Assistance Bulletin entitled
Billing Updates for COVID-19 Vaccine Counseling Only Visits for Beneficiaries Under the Age of 21
05/16/2023
Added Remittance Advice Dates -
June 2023 Remittance Advice Dates
05/12/2023
Updated Provider Quick Tips - The following Quick Tips have been updated to the website.
Updated #230 -
COVID-19 Response: Pharmacies May Override Early Refill Alerts for Medications
05/09/2023
Updated Provider Quick Tips - The following Quick Tips have been updated to the website.
Updated #233 -
Waiver of Prudent Pay During COVID-19 Emergency
05/08/2023
Added the updated
Pennsylvania Medicaid Managed Care Directory
05/01/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #263 -
180 Day Electronic Process - Updated 05/01/2023
04/27/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #263 -
180 Day Electronic Process - Updated 04/27/2023
04/24/2023
Added Managed Care Enrollment Information:
Added
March 2023
04/17/2023
Added Remittance Advice Dates -
May 2023 Remittance Advice Dates
04/13/2023
Added MA Bulletin numbered:
01-23-04 A Medical Assistance Bulletin entitled
Additional Bivalent SARS-CoV-2 Vaccine Doses Manufactured by Moderna, Inc. and Pfizer, Inc.
99-23-02 A Medical Assistance Bulletin entitled
Updates to the Emergency Medical Condition Information Eligibility Form (PA 1917)
04/12/2023
Added MA Bulletin numbered:
99-23-03 A Medical Assistance Bulletin entitled
2023 Recommended Child and Adolescent Immunization Schedule
Added Provider Quick Tips - The following Quick Tips have been added to the website.
Updated #41 - Medical Assistance Desk Reference (updated April 2023)
04/04/2023
Added MA Bulletin numbered:
17-23-01 A Medical Assistance Bulletin entitled
Implementation of ADA Claim Form – Version 2019
04/03/2023
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #263 -
180 Day Electronic Process - Updated 3/30/2023
03/28/2023
Added MA Bulletin numbered:
99-23-01 A Medical Assistance Bulletin entitled
Medical Assistance Program Fee Schedule Revisions
03/24/2023
Added MA Bulletin numbered:
01-23-03 A Medical Assistance Bulletin entitled
Administration of Booster Dose of SARS-CoV-2 Vaccine Manufactured by Novavax
03/22/2023
Added Managed Care Enrollment Information:
Added
February 2023
03/21/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
03/17/2023
Added Remittance Advice Dates -
April 2023 Remittance Advice Dates
03/08/2023
Updated Provider Quick Tips - The following Quick Tips have been added to the website.
#121 -
Certification Renewal Required for Medical Assistance (MA) Providers Dispensing Hearing Aid Supplies (revised February 2023)
#176 -
Presumptive Eligibility for Pregnant Women - 2023 Income Limits
03/03/2023
Added the updated
Pennsylvania Medicaid Managed Care Directory
03/02/2023
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Date of Death Recovery
02/22/2023
Added Managed Care Enrollment Information:
Added
January 2023
02/17/2023
Added MA Bulletin numbered:
05-23-02 A Medical Assistance Bulletin entitled
Coverage of Case Specific Training/Shadow Nursing for Private Duty/Shift Nursing Services for MA Beneficiaries Under 21 Years of Age
Added Remittance Advice Dates -
March 2023 Remittance Advice Dates
02/08/2023
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #266 -
New Group Provider Access for Reactivation/Revalidation Changes of Group Members (Fee Assigned Practitioners)
02/03/2023
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #266 -
New Group Provider Access for Reactivation/Revalidation Changes of Group Members (Fee Assigned Practitioners)
01/31/2023
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #265 -
How to Check the Status of Your Electronic Provider Enrollment Application/Actions to Take if Your Application Was Returned for Additional Information
01/26/2023
Added MA Bulletin numbered:
26-23-02 A Medical Assistance Bulletin entitled
2023 Ambulance Fee Increases
01/23/2023
Added Managed Care Enrollment Information:
Added
December 2022
01/20/2023
Added MA Bulletin numbered:
01-23-01 A Medical Assistance Bulletin entitled
Addition of Bivalent Booster Dose of the SARS-CoV-2 Vaccines Manufactured by Pfizer, Inc. and Moderna, Inc.
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #263 -
180 Day Electronic Process - updated 1/20/23
01/19/2023
Added MA Bulletin numbered:
01-23-02 A Medical Assistance Bulletin entitled
Rescind 340B Drug Pricing Program - Dispensing 340B Purchased Drugs
01/17/2023
Added the updated
Pennsylvania Medicaid Managed Care Directory
Added Remittance Advice Dates -
February 2023 Remittance Advice Dates
01/04/2023
Added Managed Care Enrollment Information:
Added
November 2022
12/30/2022
Added Provider Quick Tips - The following Quick Tips have been added to the website.
Updated #41 - Medical Assistance Desk Reference (updated December 2022)
12/29/2022
Added MA Bulletin numbered:
99-22-11 A Medical Assistance Bulletin entitled
Reinstatement of Provider Enrollment Requirements
12/23/2022
Added the updated
Pennsylvania Medicaid Managed Care Directory
12/22/2022
Added MA Bulletin numbered:
01-22-78 A Medical Assistance Bulletin entitled
340B Drug Pricing Program - Dispensing 340B Purchased Drugs
12/19/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
12/16/2022
Added Remittance Advice Dates -
January 2023 Remittance Advice Dates
12/13/2022
Added MA Bulletin numbered:
01-22-63 A Medical Assistance Bulletin entitled
Prior Authorization of Hypoglycemics, Incretin Mimetics/Enhancers – Pharmacy Services
05-22-14 A Medical Assistance Bulletin entitled
Disposable Breast Milk Collection and Storage Bags and Breast Pump
12/09/2022
Added MA Bulletin numbered:
01-22-50 A Medical Assistance Bulletin entitled
Prior Authorization of Monoclonal Antibodies - Anti-IL, Anti-IgE, Anti-TSLP (Formerly Monoclonal Antibodies - Anti-IL, Anti-IgE) - Pharmacy Services
01-22-75 A Medical Assistance Bulletin entitled
Statewide Preferred Drug List (PDL) Updates - Pharmacy Services
01-22-70 A Medical Assistance Bulletin entitled
Coverage and Prior Authorization of Obesity Treatment Agents - Pharmacy Services
12/08/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Updated -
#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)
Added MA Bulletin numbered:
01-22-73 A Medical Assistance Bulletin entitled
Prior Authorization of Platelet Aggregation Inhibitors - Pharmacy Services
01-22-65 A Medical Assistance Bulletin entitled
Prior Authorization of Hypoglycemics, SGLT2 Inhibitors - Pharmacy Services
01-22-72 A Medical Assistance Bulletin entitled
Prior Authorization of Pituitary Suppressive Agents, LHRH - Pharmacy Services
01-22-71 A Medical Assistance Bulletin entitled
Prior Authorization of Ophthalmics, Anti-Inflammatories - Pharmacy Services
12/07/2022
Added MA Bulletin numbered:
01-22-68 A Medical Assistance Bulletin entitled
Prior Authorization of Lipotropics, Other - Pharmacy Services
01-22-74 A Medical Assistance Bulletin entitled
Prior Authorization of Stimulants and Related Agents - Pharmacy Services
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Updated -
#264 – Electronic Visit Verification
Added Managed Care Enrollment Information:
Added
September 2022
and
October2022
12/02/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added -
#264 – Electronic Visit Verification
11/10/2022
Added MA Bulletin numbered:
26-22-07 A Medical Assistance Bulletin entitled
2023 Ambulance Fee Increases
24-22-32 A Medical Assistance Bulletin entitled
At-Home Over-The-Counter COVID-19 Tests
01-22-57 A Medical Assistance Bulletin entitled
Prior Authorization of Dry Eye Treatments (Formerly Ophthalmics, Immunomodulators) - Pharmacy Services
01-22-64 A Medical Assistance Bulletin entitled
Prior Authorization of Hypoglycemics, Insulin and Related Agents - Pharmacy Services
01-22-66 A Medical Assistance Bulletin entitled
Prior Authorization of Hypoglycemics, TZDs - Pharmacy Services
01-22-67 A Medical Assistance Bulletin entitled
Prior Authorization of Immunomodulators, Atopic Dermatitis - Pharmacy Services
01-22-69 A Medical Assistance Bulletin entitled
Prior Authorization of NSAIDs - Pharmacy Services
11/09/2022
Added MA Bulletin numbered:
01-22-60 A Medical Assistance Bulletin entitled
Prior Authorization of Glucocorticoids, Inhaled - Pharmacy Services
01-22-61 A Medical Assistance Bulletin entitled
Prior Authorization of Glucocorticoids, Oral - Pharmacy Services
01-22-62 A Medical Assistance Bulletin entitled
Prior Authorization of Hepatitis C Agents - Pharmacy Services
01-22-49 A Medical Assistance Bulletin entitled
Prior Authorization of Antihemophilia Agents - Pharmacy Services
01-22-45 A Medical Assistance Bulletin entitled
Prior Authorization of Angiotensin Modulator Combinations - Pharmacy Services
01-22-54 A Medical Assistance Bulletin entitled
Prior Authorization of Bile Salts - Pharmacy Services
01-22-56 A Medical Assistance Bulletin entitled
Prior Authorization of Cytokine and CAM Antagonists - Pharmacy Services
11/08/2022
Added MA Bulletin numbered:
01-22-47 A Medical Assistance Bulletin entitled
Prior Authorization of Antibiotics, GI and Related Agents - Pharmacy Services
01-22-48 A Medical Assistance Bulletin entitled
Prior Authorization of Antifibrotic Respiratory Agents (Formerly Idiopathic Pulmonary Fibrosis (IPF) Agents) - Pharmacy Services
01-22-52 A Medical Assistance Bulletin entitled
Prior Authorization of Antipsychotics - Pharmacy Services
01-22-53 A Medical Assistance Bulletin entitled
Prior Authorization of Antivirals, CMV - Pharmacy Services
01-22-55 A Medical Assistance Bulletin entitled
Prior Authorization of Corticotropin (formerly H.P. Acthar Gel) - Pharmacy Services
01-22-58 A Medical Assistance Bulletin entitled
Prior Authorization of Dupixent (dupilumab) - Pharmacy Services
01-22-59 A Medical Assistance Bulletin entitled
Prior Authorization of GI Motility, Chronic Agents - Pharmacy Services
11/04/2022
Added the updated
Pennsylvania Medicaid Managed Care Directory
Added MA Bulletin numbered:
01-22-43 A Medical Assistance Bulletin entitled
Prior Authorization of Acne Agents, Oral - Pharmacy Services
01-22-44 A Medical Assistance Bulletin entitled
Prior Authorization of Alcohol Use Disorder Agents – Pharmacy Services
01-22-46 A Medical Assistance Bulletin entitled
Prior Authorization of Antianginal Agents - Pharmacy Services
01-22-51 A Medical Assistance Bulletin entitled
Prior Authorization of Antipsoriatics, Topical - Pharmacy Services
99-22-10 A Medical Assistance Bulletin entitled
Enrollment of Providers for Medicare Cost-Sharing Only
11/03/2022
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on December 7th, 2022 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on December 8th, 2022 at 10:00AM EDT -
Register here
.
11/02/2022
Added Remittance Advice Dates -
December 2022 Remittance Advice Dates
10/17/2022
Added MA Bulletin numbered:
01-22-18 Medical Assistance Bulletin entitled -
SARS-CoV-2 Vaccine Booster Manufactured by Moderna, Inc.
Added Remittance Advice Dates -
November 2022 Remittance Advice Dates
10/07/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #263 -
180 Day Electronic Process
Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on October 13, 2022 at 10:00AM EDT -
Register here
.
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on October 26, 2022 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on October 27, 2022 at 10:00AM EDT -
Register here
.
09/29/2022
Added Managed Care Enrollment Information:
Added
August 2022
09/28/2022
Added MA Bulletin numbered:
01-22-39 Medical Assistance Bulletin entitled -
Updates to Pediatric SARS-CoV-2 Vaccines Manufactured by Pfizer, Inc. and Moderna, Inc.
09/26/2022
Added MA Bulletin numbered:
05-22-08 Medical Assistance Bulletin entitled -
Additions to the Medical Assistance Fee Schedule for Private Duty Nursing Services Provided to Beneficiaries Under the Age of 21.
09/23/2022
Added MA Bulletin numbered:
01-22-12 Medical Assistance Bulletin entitled -
COVID-19 Vaccine Counseling Only Visits for Beneficiaries Under 21
09/22/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #260 -
Provider Electronic Portal Update
09/20/2022
Added MA Bulletin numbered:
01-22-14 Medical Assistance Bulletin entitled -
Vaccine Counseling Only Visits for Beneficiaries Under 21
09/19/2022
Added MA Bulletin numbered:
01-22-38 Medical Assistance Bulletin entitled -
Administration of SARS-CoV-2 Vaccine Manufactured by Novavax
99-22-07 Medical Assistance Bulletin entitled -
Pennsylvania’s Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
Added the updated
Pennsylvania Medicaid Managed Care Directory
09/16/2022
Added Remittance Advice Dates -
October 2022 Remittance Advice Dates
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Provider Enrollment Summary Enhancements
09/15/2022
Added MA Bulletin numbered:
35-22-02 Medical Assistance Bulletin entitled -
School-Based ACCESS Program Provider Handbook
09/14/2022
Added MA Bulletin numbered:
01-22-42 Medical Assistance Bulletin entitled -
Adult Vaccine Procedure Code Updates and Additions
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
09/13/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #262 -
Provider Enrollment Summary Enhancements
09/12/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Delay in Hospice Rates for FY 2023
09/09/2022
Added the updated
Pennsylvania Medicaid Managed Care Directory
09/07/2022
Added MA Bulletin numbered:
27-22-27 Medical Assistance Bulletin entitled -
2022 Medical Assistance Program Dental Fee Schedule Update
09/06/2022
Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on September 8, 2022 at 10:00AM EDT -
Register here
.
09/02/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Corrections to Cycle 07 & 66 Credits (Accounts Receivables) recoupments
Community Support Service Providers - Federal Financial Participation Rate Change and Continued Billing Requirements
Provider Enrollment Summary Enhancements
09/01/2022
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on September 21, 2022 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on September 22, 2022 at 10:00AM EDT -
Register here
.
Added Managed Care Enrollment Information:
Added
July 2022
08/29/2022
Added MA Bulletin numbered:
08-22-19 Medical Assistance Bulletin entitled -
Naloxone Distribution by Federally Qualified Health Centers and Rural Health Clinics
01-22-41 Medical Assistance Bulletin entitled -
Additions to the Medical Assistance Fee Schedule for Monkeypox Laboratory Testing and Vaccines
08/26/2022
Added MA Bulletin numbered:
08-22-44 Medical Assistance Bulletin entitled -
Addition of Behavioral Health Providers to Certain Procedure Codesand other Procedure Code Changes
99-22-05 Medical Assistance Bulletin entitled -
2022 Healthcare Common Procedure Coding System (HCPCS) Updates and Other Procedure Code Changes
01-22-15 Medical Assistance Bulletin entitled -
Adult Vaccine Procedure Code Updates and Additions
- OBSOLETE
08/19/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Date of Death Recovery
08/16/2022
Added Remittance Advice Dates -
September 2022 Remittance Advice Dates
Added Remittance Advice Alert - The following Remittance Advice Alert/PROMISe™ Banner page has been added to the website.
Financial Cycle 66 Continuation of Financial Cycle 07
08/10/2022
Added MA Bulletin numbered:
05-22-09 Medical Assistance Bulletin entitled -
Electronic Visit Verification Requirements for Home Health Care Services in the Fee-for-Service Delivery and Managed Care Delivery Systems
08/01/2022
Added Managed Care Enrollment Information:
Added
May 2022
and
June 2022
07/29/2022
Added Managed Care Enrollment Information:
Added
April 2022
07/26/2022
Added Remittance Advice Dates -
August 2022 Remittance Advice Dates
07/14/2022
Added MA Bulletin numbered:
01-22-26 Medical Assistance Bulletin entitled -
Prior Authorization of Epinephrine, Self-Injected - Pharmacy Services
01-22-28 Medical Assistance Bulletin entitled -
Prior Authorization of Hypoglycemics, Alpha Glucosidase Inhibitors - Pharmacy Services
01-22-29 Medical Assistance Bulletin entitled -
Prior Authorization of Hypoglycemics, Metformins - Pharmacy Services
07/13/2022
Added MA Bulletin numbered:
01-22-24 Medical Assistance Bulletin entitled -
Prior Authorization of Contraceptives, Oral - Pharmacy Services
01-22-25 Medical Assistance Bulletin entitled -
Prior Authorization of Contraceptives, Other - Pharmacy Services
01-22-19 Medical Assistance Bulletin entitled -
Prior Authorization of Acne Agents, Topical - Pharmacy Services
01-22-27 Medical Assistance Bulletin entitled -
Prior Authorization of Hepatitis B Agents - Pharmacy Services
07/11/2022
Added MA Bulletin numbered:
01-22-23 Medical Assistance Bulletin entitled -
Prior Authorization of Antipsoriatics, Oral - Pharmacy Services
01-22-22 Medical Assistance Bulletin entitled -
Prior Authorization of Antiparkinson’s Agents - Pharmacy Services
01-22-21 Medical Assistance Bulletin entitled -
Prior Authorization of Antihypertensives, Sympatholytic - Pharmacy Services
01-22-20 Medical Assistance Bulletin entitled -
Prior Authorization of Antibiotics, Topical - Pharmacy Services
07/08/2022
Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on July 14, 2022 at 10:00AM EDT -
Register here
.
Added MA Bulletin numbered:
01-22-31 Medical Assistance Bulletin entitled -
Prior Authorization of Immunomodulators, Topical – Pharmacy Services
01-22-30 Medical Assistance Bulletin entitled -
Prior Authorization of Hypoglycemics, Sulfonylureas – Pharmacy Services
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on July 27, 2022 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on July 28, 2022 at 10:00AM EDT -
Register here
.
07/07/2022
Added MA Bulletin numbered:
01-22-33 Medical Assistance Bulletin entitled -
Prior Authorization of Lipotropics, Statins – Pharmacy Services
.
01-22-32 Medical Assistance Bulletin entitled -
Prior Authorization of Leukotriene Modifiers – Pharmacy Services
.
07/06/2022
Added MA Bulletin numbered:
09-22-37 Medical Assistance Bulletin entitled -
Disposable Surgical Masks
.
01-22-35 Medical Assistance Bulletin entitled -
Prior Authorization of Phosphate Binders - Pharmacy Services
.
01-22-34 Medical Assistance Bulletin entitled -
Prior Authorization of Methotrexate – Pharmacy Services
.
07/05/2022
Added MA Bulletin numbered:
01-22-37 Medical Assistance Bulletin entitled -
Prior Authorization of Thyroid Hormones - Pharmacy Services
.
01-22-36 Medical Assistance Bulletin entitled -
Prior Authorization of Smoking Cessation Products– Pharmacy Services
.
07/01/2022
Added MA Bulletin numbered:
05-22-02 Medical Assistance Bulletin entitled -
Reinstatement of Prior Authorization Requirements for Shift Care Services for Beneficiaries Under 21 Years of Age
06/30/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #85 -
Department of Human Services (DHS) Breast & Cervical Cancer Prevention & Treatment (BCCPT) Program Updated July 2022
06/21/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
06/17/2022
Added Remittance Advice Dates -
July  2022 Remittance Advice Dates
06/13/2022
Added MA Bulletin numbered:
08-22-13 Medical Assistance Bulletin entitled -
Teledentistry Guidelines and Dental Fee Schedule Updates
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on June 22, 2022 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on June 23, 2022 at 10:00AM EDT -
Register here
.
06/10/2022
Added MA Bulletin numbered:
08-20-68 Medical Assistance Bulletin entitled -
Federally Qualified Health Center and Rural Health Clinic Payment for SARS-CoV-2 Vaccine Administration
06/08/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #261 -
Important Changes are Coming for the Physical Health HealthChoices Program
06/06/2022
Added MA Bulletin numbered:
01-22-13 Medical Assistance Bulletin entitled -
Updates to Blood Lead Reference Value and Environmental Lead Investigation (ELI) Provider Qualifications Requirements
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #260 -
Provider Electronic Portal Update
06/03/2022
Added MA Bulletin numbered:
01-22-16 A Medical Assistance Bulletin entitled -
Third Dose of Pediatric SARS-CoV-2 Vaccine Manufactured by Pfizer, Inc.
01-22-17 A Medical Assistance Bulletin entitled -
Addition to Medical Assistance Program Fee Schedule for Administration of Ready-to-Use SARS-CoV-2 Vaccine Manufactured by Pfizer, Inc.
06/02/2022
Added Managed Care Delivery System Subcommittee agenda and draft file note - The June 2022 Managed Care Delivery System Subcommittee agenda and May 2022 draft file note have been posted and can be accessed from the
Meeting Minutes
archives page.
Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on June 9, 2022 at 10:00AM EDT -
Register here
.
05/19/2022
Added Remittance Advice Dates -
June 2022 Remittance Advice Dates
05/12/2022
Added MA Bulletin numbered:
99-22-03 A Medical Assistance Bulletin entitled -
2022 Recommended Child and Adolescent Immunization Schedule
05/10/2022
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on May 25, 2022 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on May 26, 2022 at 10:00AM EDT -
Register here
.
05/09/2022
Added MA Bulletin numbered:
01-22-11 A Medical Assistance Bulletin entitled -
Addition of Monoclonal Antibody Product Bebtelovimab to the MA Program Fee Schedule
05/06/2022
Added MA Bulletin numbered:
99-22-02 A Medical Assistance Bulletin entitled -
Updates to Guidelines for the Delivery of Physical Health Services via Telemedicine
Added Managed Care Delivery System Subcommittee agenda and draft file note - The May 2022 Managed Care Delivery System Subcommittee agenda and April 2022 draft file note have been posted and can be accessed from the
Meeting Minutes
archives page.
Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on May 12, 2022 at 10:00AM EDT -
Register here
.
05/02/2022
Added MA Bulletin numbered:
35-22-01 A Medical Assistance Bulletin entitled -
School-Based ACCESS Program Provider Handbook Mid-Year Update
04/28/2022
Added the updated
Pennsylvania Medicaid Managed Care Directory
04/26/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Date of Death Recovery
04/21/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
New Procedure Codes added to PA Medical Assistance Program Fee Schedule
Added Managed Care Enrollment Information:
Added
March  2022
04/19/2022
Added Remittance Advice Dates -
May 2022 Remittance Advice Dates
04/18/2022
Added MA Bulletin numbered:
05-22-01 A Medical Assistance Bulletin entitled -
Additions to the Medical Assistance Fee Schedule for Personal Care Services Provided to Beneficiaries Under the Age of 21.
04/15/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #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
04/11/2022
Added Managed Care Delivery System Subcommittee agenda and draft file note - The April 2022 Managed Care Delivery System Subcommittee agenda and March 2022 draft file note have been posted and can be accessed from the
Meeting Minutes
archives page.
Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on April 14, 2022 at 10:00AM EDT -
Register here
.
04/07/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Provider Electronic Solutions Software or PES is Sunsetting
04/06/2022
Added Managed Care Enrollment Information:
Added
January 2022
Added
February 2022
03/31/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Ordering, Referring and Prescribing Provider Enrollment Requirements
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on April 27, 2022 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on April 28, 2022 at 10:00AM EDT -
Register here
.
Added MA Bulletin numbered:
99-22-01 A Medical Assistance Bulletin entitled -
Extension of Postpartum Coverage from 60 days to 12 Months
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #258 -
Provider Electronic Solutions Software
03/30/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #257 -
Medicare Sequestration Payment Reductions on All Claims Media Fee-for-Service (FFS) Claims Reinstated
03/25/2022
Added MA Bulletin numbered:
01-22-07 A Medical Assistance Bulletin entitled -
Additions to the Medical Assistance Program Fee Schedule for Multiple Respiratory Pathogens Laboratory Tests
03/24/2022
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
03/22/2022
Added MA Bulletin numbered:
01-22-09 A Medical Assistance Bulletin entitled -
Prior Authorization of Anticonvulsants – Pharmacy Services
01-22-10 A Medical Assistance Bulletin entitled -
Prior Authorization of Sedative Hypnotics – Pharmacy Services
03/21/2022
Added MA Bulletin numbered:
01-21-13 A Medical Assistance Bulletin entitled -
MenQuadfi® and Vaxelis® Vaccines
03/17/2022
Added Remittance Advice Dates -
April 2022 Remittance Advice Dates
03/11/2022
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on March 23, 2022 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on March 24, 2022 at 10:00AM EDT -
Register here
.
03/07/2022
Added MA Bulletin numbered:
01-21-60 A Medical Assistance Bulletin entitled -
Update to Age Limits for Payment for Administration of the Flucelvax® Quadrivalent Vaccine
03/04/2022
Updated Provider Quick Tips - The following Quick Tips have been added to the website.
#121 -
Certification Renewal Required for Medical Assistance (MA) Providers Dispensing Hearing Aid Supplies (revised February 2022)
#176 -
Presumptive Eligibility for Pregnant Women - 2022 Income Limits
03/02/2022
Added the updated
Pennsylvania Medicaid Managed Care Directory
02/28/2022
Updated Healthy Beginnings Plus -
Current Provider List
02/24/2022
Added MA Bulletin numbered:
01-21-59 A Medical Assistance Bulletin entitled -
SARs-CoV-2 Monoclonal Antibody Product Updates
08-20-66 A Medical Assistance Bulletin entitled -
Federally Qualified Health Center and Rural Health Clinic Payment for SARS-CoV-2 Vaccine Administration
02/18/2022
Added Remittance Advice Dates -
March 2022 Remittance Advice Dates
02/14/2022
Added MA Bulletin numbered:
01-22-02 A Medical Assistance Bulletin entitled -
Community-Based Care Management Services Provided by Centers of Excellence for Opioid Use Disorders (COEs)
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on February 23, 2022 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on February 24, 2022 at 10:00AM EDT -
Register here
.
02/09/2022
Added MA Bulletin numbered:
01-22-08 A Medical Assistance Bulletin entitled -
Preferred Specialty Pharmacy Drug Program Provider - Pharmacy Services
02/02/2022
Added Managed Care Enrollment Information:
Added
December 2021
02/01/2022
Added MA Bulletin numbered:
24-21-55 A Medical Assistance Bulletin entitled -
At-Home Over-The-Counter COVID-19 Tests
Added Managed Care Enrollment Information:
Added
November 2021
01/28/2022
Added the updated
Pennsylvania Medicaid Managed Care Directory
01/25/2022
Added MA Bulletin numbered:
01-22-06 A Medical Assistance Bulletin entitled -
SARS-CoV-2 (COVID-19) Oral Antiviral Treatments with emergency use authorization (EUA) from the U.S. Food and Drug Administration (FDA)
01/24/2022
Added Managed Care Enrollment Information:
Added
October 2021
01/18/2022
Added Remittance Advice Dates -
February 2022 Remittance Advice Dates
01/12/2022
Added MA Bulletin numbered:
01-22-03 A Medical Assistance Bulletin entitled -
Prior Authorization of Aduhelm (aducanumab) - Pharmacy Services
01/11/2022
Added MA Bulletin numbered:
01-22-04 A Medical Assistance Bulletin entitled -
Prior Authorization of Xyrem (sodium oxybate)/Xywav (calcium, magnesium, potassium, and sodium oxybates) - Pharmacy Services
01/07/2022
Added MA Bulletin numbered:
01-22-05 A Medical Assistance Bulletin entitled -
Billing Procedure Update for Certified Registered Nurse Practitioners and Physicians Assistants
Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on January 26, 2022 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on January 27, 2022 at 10:00AM EDT -
Register here
.
12/30/2021
Added MA Bulletin numbered:
01-21-19 A Medical Assistance Bulletin entitled -
Vaccine Administration by Pharmacists - Pharmacy Services
12/28/2021
Added MA Bulletin numbered:
01-21-55 A Medical Assistance Bulletin entitled -
Administration of a Booster Dose of the SARS-CoV-2 Vaccines
01-21-58 A Medical Assistance Bulletin entitled -
Prior Authorization of HIV/AIDS Antiretrovirals - Pharmacy Services
12/27/2021
Added MA Bulletin numbered:
01-21-51 A Medical Assistance Bulletin entitled -
Pediatric SARS-CoV-2 Vaccine Manufactured by Pfizer, Inc.
05-21-10 A Medical Assistance Bulletin entitled -
Medical Assistance Program Fee Increases for Private Duty / Shift Nursing Services to MA Beneficiaries Under 21 Years of Age
12/21/2021
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
12/17/2021
Added Remittance Advice Dates -
January 2022 Remittance Advice Dates
12/16/2021
Added MA Bulletin numbered:
01-21-56 A Medical Assistance Bulletin entitled -
Prior Authorization of Anticonvulsants - Pharmacy Services
01-21-57 A Medical Assistance Bulletin entitled -
Prior Authorization of Sedative Hypnotics - Pharmacy Services
12/01/2021
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on December 08, 2021 at 1:00PM EDT -
Register here
.
11/30/2021
Added MA Bulletin numbered:
27-21-02 A Medical Assistance Bulletin entitled -
2021 Medical Assistance Program Dental Fee Schedule Update
11/18/2021
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on December 9, 2021 at 10:00AM EDT -
Register here
.
Added Remittance Advice Dates -
December 2021 Remittance Advice Dates
11/17/2021
Added MA Bulletin numbered:
01-21-52 A Medical Assistance Bulletin entitled -
Prior Authorization of Growth Hormones - Pharmacy Services
01-21-53 A Medical Assistance Bulletin entitled -
Prior Authorization of Immunosuppressives, Oral - Pharmacy Services
01-21-54 A Medical Assistance Bulletin entitled -
Prior Authorization of Skeletal Muscle Relaxants - Pharmacy Services
11/16/2021
Added MA Bulletin numbered:
01-21-43 A Medical Assistance Bulletin entitled -
Prior Authorization of VMAT2 Inhibitors - Pharmacy Services
01-21-44 A Medical Assistance Bulletin entitled -
Prior Authorization of Zeposia (ozanimod) - Pharmacy Service
s
11/15/2021
Added MA Bulletin numbered:
01-21-38 A Medical Assistance Bulletin entitled -
Prior Authorization of Pulmonary Hypertension Agents, Oral and Inhaled - Pharmacy Services
01-21-39 A Medical Assistance Bulletin entitled -
Prior Authorization of Rilutek (riluzole) -Pharmacy Service
s-OBSOLETE
01-21-40 A Medical Assistance Bulletin entitled -
Statewide Preferred Drug List (PDL) Implementation - Pharmacy Services
01-21-41 A Medical Assistance Bulletin entitled -
Prior Authorization of Tysabri (natalizumab) - Pharmacy Services
01-21-42 A Medical Assistance Bulletin entitled -
Prior Authorization of Ulcerative Colitis Agents - Pharmacy Services
Added MA Bulletin numbered:
01-21-31 A Medical Assistance Bulletin entitled -
Prior Authorization of Lipotropics, Other - Pharmacy Services
01-21-32 A Medical Assistance Bulletin entitled -
Prior Authorization of Monoclonal Antibodies (MABs) - Anti-IL Anti-IgE - Pharmacy Service
s
01-21-35 A Medical Assistance Bulletin entitled -
Prior Authorization of Multiple Sclerosis Agents - Pharmacy Services
01-21-36 A Medical Assistance Bulletin entitled -
Prior Authorization of Opioid Dependence Treatments - Pharmacy Services
01-21-37 A Medical Assistance Bulletin entitled -
Prior Authorization of Pituitary Suppressive Agents, LHRH - Pharmacy Services
11/10/2021
Added MA Bulletin numbered:
01-21-30 A Medical Assistance Bulletin entitled -
Prior Authorization of Immunomodulators, Atopic Dermatitis - Pharmacy Services
01-21-33 A Medical Assistance Bulletin entitled -
Prior Authorization of Migraine Acute Treatment Agents - Pharmacy Service
s
01-21-34 A Medical Assistance Bulletin entitled -
Prior Authorization of Migraine Prevention Agents - Pharmacy Services
01-21-47 A Medical Assistance Bulletin entitled -
Prior Authorization of Glucocorticoids, Inhaled - Pharmacy Services
01-21-48 A Medical Assistance Bulletin entitled -
Prior Authorization of Hepatitis C Agents - Pharmacy Services
Added the updated
Pennsylvania Medicaid Managed Care Directory
11/08/2021
Added MA Bulletin numbered:
01-21-25 A Medical Assistance Bulletin entitled -
Prior Authorization of Botulinum Toxins (Type A and Type B) - Pharmacy Services
01-21-27 A Medical Assistance Bulletin entitled -
Prior Authorization of Chronic Obstructive Pulmonary Disease (COPD) Agents - Pharmacy Service
s
01-21-45 A Medical Assistance Bulletin entitled -
Prior Authorization of Erythropoiesis Stimulating Agents (ESAs) - Pharmacy Services
01-21-46 A Medical Assistance Bulletin entitled -
Prior Authorization of GI Motility, Chronic Agents - Pharmacy Services
01-21-49 A Medical Assistance Bulletin entitled -
Prior Authorization of HIV/AIDS Antiretrovirals - Pharmacy Services
11/05/2021
Added MA Bulletin numbered:
01-21-23 A Medical Assistance Bulletin entitled -
Prior Authorization of Bladder Relaxant Preparations - Pharmacy Services
01-21-24 A Medical Assistance Bulletin entitled -
Prior Authorization of Bone Density Regulators - Pharmacy Service
s
01-21-26 A Medical Assistance Bulletin entitled -
Prior Authorization of Bronchodilators, Beta Agonists - Pharmacy Services
01-21-28 A Medical Assistance Bulletin entitled -
Prior Authorization of Cytokine and CAM Antagonists - Pharmacy Services
01-21-29 A Medical Assistance Bulletin entitled -
Prior Authorization of Dupixent (dupilumab) - Pharmacy Services
11/04/2021
Added MA Bulletin numbered:
01-21-20 A Medical Assistance Bulletin entitled -
Prior Authorization of Antiparasitics, Topical - Pharmacy Services
01-21-21  A Medical Assistance Bulletin entitled -
Prior Authorization of Antipsychotics - Pharmacy Services
01-21-22 A Medical Assistance Bulletin entitled -
Prior Authorization of Anxiolytics - Pharmacy Services
11/02/2021
Added MA Bulletin numbered:
01-21-14 A Medical Assistance Bulletin entitled -
Prior Authorization of Alzheimer’s Agents - Pharmacy Services
01-21-15 A Medical Assistance Bulletin entitled -
Prior Authorization of Antibiotics, GI and Related Agents - Pharmacy Services
01-21-16 A Medical Assistance Bulletin entitled -
Prior Authorization of Antifungals, Topical - Pharmacy Services
01-21-17 A Medical Assistance Bulletin entitled -
Prior Authorization of Antihemophilia Agents - Pharmacy Services
01-21-18 A Medical Assistance Bulletin entitled -
Prior Authorization of Antihyperuricemics - Pharmacy Services
10/28/2021
Added Managed Care Enrollment Information:
Added
September 2021
10/22/2021
Added MA Bulletin numbered:
05-21-04 A Medical Assistance Bulletin entitled -
Updated Error Status Code Descriptions for Personal Care Services Subject to Electronic Visit Verification
10/21/2021
Added MA Bulletin numbered:
08-21-07 A Medical Assistance Bulletin entitled -
Naloxone Distribution by Federally Qualified Health Centers and Rural Health Clinics
10/19/2021
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #240 -
Provider enrollment and revalidation changes during the COVID-19 emergency
10/18/2021
Added Remittance Advice Dates -
November 2021 Remittance Advice Dates
10/15/2021
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #207 -
MA Program Fee Schedule Updates for Act 62 Procedure Codes
10/13/2021
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on October 27, 2021 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on October 28, 2021 at 10:00AM EDT -
Register here
.
10/12/2021
Added Hospital Assessment Initiative  - The following Potentially Avoidable Admissions pages have been added to the website.
Hospital Quality Incentive Program Webinar
Hospital Quality Incentive Program (HQIP) Measurement - Potentially Avoidable Admission (PAA)
10/07/2021
Added PROMISeTM Provider Handbooks and Billing Guides Information:
Updated
837 Professional / CMS-1500 Claim Form
Updated
CMS-1500 Billing Guide for PROMISeTM Healthy Beginnings Plus (HBP) Providers
10/04/2021
Added Managed Care Enrollment Information:
Added
August 2021
09/30/2021
Added MA Bulletin numbered
99-21-06 A Medical Assistance Bulletin entitled -
Guidelines for the Delivery of Physical Health Services via Telemedicine
09/28/2021
Added Provider Quick Tips - The following Quick Tips have been added to the website.
Added #256 - Procedure Code/Modifier Combinations to be Utilized when Requesting Home Accessibility Durable Medical Equipment (DME) in the Fee-for-Service Delivery System
09/24/2021
Added MA Bulletin numbered:
01-21-06 A Medical Assistance Bulletin entitled -
Updates to the Family Planning Services Program Fee Schedule
09/23/2021
Added the updated
Pennsylvania Medicaid Managed Care Directory
09/22/2021
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
09/21/2021
Added MA Bulletin numbered:
09-21-04 A Medical Assistance Bulletin entitled -
Coverage of Home Accessibility Durable Medical Equipment and Procedure for obtaining an 1150 Administrative Waiver in the Fee-for-Service Delivery System
Added Provider Quick Tips - The following Quick Tips have been added to the website.
Added #255 - Provider Revalidation Requirements
09/20/2021
Added Remittance Advice Dates -
October 2021 Remittance Advice Dates
09/17/2021
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Provider Revalidation Reinstated June 1, 2021
09/10/2021
Added Managed Care Enrollment Information:
Added
July 2021
09/08/2021
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Community Support Service Providers - Federal Financial Participation Rate Change and Continued Billing Requirements
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on September 22, 2021 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on September 23, 2021 at 10:00AM EDT -
Register here
.
09/03/2021
Added MA Bulletin numbered:
01-21-12 A Medical Assistance Bulletin entitled —
Administration of a Third Dose of SARS-CoV-2 Vaccines Manufactured by Pfizer, Inc. and Moderna, Inc
08/20/2021
Added Remittance Advice Dates -
September 2021 Remittance Advice Dates
Added MA Bulletin numbered:
99-21-04 A Medical Assistance Bulletin entitled
2021 Healthcare Common Procedure Coding System (HCPCS) Updates, Fee Adjustments and Other Procedure Code Changes
.
07/30/2021
Added MA Bulletin numbered:
01-21-11 A Medical Assistance Bulletin entitled
Corrected - Expansion of Providers for the Administration of SARS-CoV-2 Vaccines and Monoclonal Antibody Therapy
07/29/2021
Added MA Bulletin numbered:
01-21-04 A Medical Assistance Bulletin entitled
SARS-CoV-2 Vaccine Administration for Beneficiaries who are Homebound
01-21-08 A Medical Assistance Bulletin entitled
Expansion of Providers for the Administration of SARS-CoV-2 Vaccines and Monoclonal Antibody Therapy
- OBSOLETE
07/27/2021
Added the updated
Pennsylvania Medicaid Managed Care Directory
07/22/2021
Added Managed Care Enrollment Information:
Added
April 2021
,
May 2021
and
June 2021
07/16/2021
Added Remittance Advice Dates -
August 2021 Remittance Advice Dates
07/08/2021
Added MA Bulletin numbered:
OMHSAS-21-06 A Medical Assistance Bulletin entitled
Opioid Treatment Program Services for Dually Eligible Individuals
07/06/2021
Added MA Bulletin numbered:
24-21-05 A Medical Assistance Bulletin entitled
Medical Assistance Program Fee Increase for Disposable Gloves
07/02/2021
Updated Provider Enrollment Documents:
11 - Mental Health/Substance Abuse Services Providers
Mental Health/Substance Abuse Provider Requirements
21 - Case Manager
Case ManagerRequirements
06/30/2021
Added MA Bulletin numbered:
99-20-09 A Medical Assistance Bulletin entitled
Medical Assistance (MA) Program Fee Schedule Revisions
06/29/2021
Added Provider Quick Tips - The following Quick Tips have been added to the website.
Added #254 -
Payment Error Rate Measurement (PERM) Initiative for RY 2022
06/28/2021
Added MA Bulletin numbered:
99-21-05 A Medical Assistance Bulletin entitled
2021 Recommended Child and Adolescent Immunization Schedule
06/25/2021
Updated Provider Enrollment Documents:
11 - Mental Health/Substance Abuse Services Providers
Mental Health/Substance Abuse Provider Requirements
21 - Case Manager
Case ManagerRequirements
06/24/2021
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
Added MA Bulletin numbered:
99-21-02 A Medical Assistance Bulletin entitled
Pennsylvania's Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
06/23/2021
Updated Provider Quick Tips - The following Quick Tips have been updated to the website.
Updated #232 Billing Guidance for Alternative Screening Sites Related to COVID-19
Updated #233 Waiver of Prudent Pay During COVID-19 Emergency
Updated #237 Teledentistry Guidelines Related to COVID-19 for Dentists, Federally Qualified Health Centers and Rural Health Clinics
Updated #242 Telemedicine Guidelines Related to COVID-19
Updated #244 MA Eligibility During COVID-19 Emergency Disaster Declaration
Updated #247 Nonemergency Ambulance Transportation Related to COVID-19
06/22/2021
Updated Healthy Beginnings Plus -
Current Provider List
06/14/2021
Added Remittance Advice Dates -
July 2021 Remittance Advice Dates
06/04/2021
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on June 23, 2021 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on June 24, 2021 at 10:00AM EDT -
Register here
.
05/20/2021
Updated Provider Enrollment Documents:
08 - Clinic
FQHC Requirements / Additional Information
08 - Clinic
RHC Requirements / Additional Information
09 - Certified Registered Nurse Practitioner (CRNP)
CRNPRequirements
11 - Mental Health/Substance Abuse Services Providers
Mental Health/Substance Abuse Provider Requirements
17 - Therapist
TherapistRequirements
19 - Psychologist
Psychologist Requirements
21 - Case Manager
Case ManagerRequirements
31 - Physician/Physician Group
Physician Requirements
05/18/2021
Added MA Bulletin numbered:
01-20-10 A Medical Assistance Bulletin entitled
Addition of COVID-19 Antigen Laboratory Test Codes to the MA Program Fee Schedule
Added Remittance Advice Dates -
June 2021 Remittance Advice Dates
Added the updated
Pennsylvania Medicaid Managed Care Directory
04/30/2021
Added MA Bulletin numbered:
99-21-03 A Medical Assistance Bulletin entitled
Reinstatement of Prior Authorization Requirements for Certain Services
04/27/2021
Added Provider Quick Tips - The following Quick Tips have been added to the website.
Updated #41 - Medical Assistance Desk Reference (updated April 2021)
04/19/2021
Added MA Bulletin numbered:
01-21-03 A Medical Assistance Bulletin entitled
Fee Increase for the Administration of SARS-CoV-2 Vaccines
04/16/2021
Added Remittance Advice Dates -
May 2021 Remittance Advice Dates
04/15/2021
Added MA Bulletin numbered:
08-21-01 A Medical Assistance Bulletin entitled
Dental Benefit Limit Exception Process Update
04/14/2021
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on April 21, 2021 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on April 22, 2021 at 10:00AM EDT -
Register here
.
03/25/2021
Added MA Bulletin numbered:
01-20-61 A Medical Assistance Bulletin
Addition to Medical Assistance Program Fee Schedule for Administration of SARS-CoV-2 Monoclonal Antibody Therapy
03/23/2021
Added MA Bulletin numbered:
99-21-01 A Medical Assistance Bulletin
Restoration of Provider Revalidation Requirements
03/22/2021
Added MA Bulletin numbered:
01-21-02 A Medical Assistance Bulletin
Updates to the Medical Assistance Program Fee Schedule for Administration of SAR-CoV-2 Monoclonal Antibody Therapy
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
03/18/2021
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on March 24, 2021 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on March 25, 2021 at 10:00AM EDT -
Register here
.
Added Managed Care Enrollment Information:
Added
February 2021
03/15/2021
Added Remittance Advice Dates -
April 2021 Remittance Advice Dates
03/11/2021
Added MA Bulletin numbered:
01-21-01 A Medical Assistance Bulletin entitled
Administration of SARS-CoV-2 Vaccine Manufactured by Janssen Biotech, Inc.
Added the updated
Pennsylvania Medicaid Managed Care Directory
02/22/2021
Added Managed Care Enrollment Information:
Added
January 2021
02/17/2021
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on February 24, 2021 at 1:00PM EDT -
Register here
.
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on February 25, 2021 at 10:00AM EDT -
Register here
.
Added Provider Quick Tips - The following Quick Tips have been added to the website.
85 - Department of Human Services (DHS) Breast and Cervical Cancer Prevention and Treatment (BCCPT) Program (updated February 2021)
176 - Presumptive Eligibility for Pregnant Women - 2021 Income Limits
02/16/2021
Added Remittance Advice Dates -
March 2021 Remittance Advice Dates
01/28/2021
Added Provider Quick Tips - The following Quick Tips have been added to the website.
Added #253 -
Year 2020 Pennsylvania Medicaid 1099s issued by PROMISeTM
01/26/2021
Added MA Bulletin numbered:
01-20-62 A Medical Assistance Bulletin entitled
SARS-CoV-2 Vaccine Updates
Added Managed Care Enrollment Information:
Added
December 2020
01/25/2021
Added Provider Quick Tips - The following Quick Tips have been added to the website.
Added #252 -
Medical Assistance Benefits for Beneficiaries Turning 21 During the COVID-19 Emergency
01/21/2021
Added Provider Quick Tips - The following Quick Tips have been added to the website.
Updated #121 -
Certification Renewal Required for Medical Assistance (MA) Providers Dispensing Hearing Aid Supplies (revised January 2021)
01/20/2021
Added Remittance Advice Dates -
February 2021 Remittance Advice Dates
12/30/2020
Added MA Bulletin numbered:
01-20-60 A Medical Assistance Bulletin entitled
SARS-CoV-2 Vaccine Administration by Pharmacists
12/24/2020
Added MA Bulletin numbered:
01-20-59 A Medical Assistance Bulletin entitled
Addition to the Medical Assistance Program Fee Schedule for Administration of SARS-CoV-2 Vaccines
12/16/2020
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
12/15/2020
Added MA Bulletin numbered:
01-20-50 A Medical Assistance Bulletin entitled
Prior Authorization of Crysvita (burosumab) - Pharmacy Services
01-20-51 A Medical Assistance Bulletin entitled
Prior Authorization of Complement Inhibitors - Pharmacy Services
01-20-52 A Medical Assistance Bulletin entitled
Prior Authorization of Corlanor (ivabradine) - Pharmacy Services
01-20-53 A Medical Assistance Bulletin entitled
Prior Authorization of Spinraza (nusinersen) - Pharmacy Services
01-20-54 A Medical Assistance Bulletin entitled
Prior Authorization of Tepezza (teprotumumab) - Pharmacy Services
12/14/2020
Added MA Bulletin numbered:
01-20-49 A Medical Assistance Bulletin entitled
Prior Authorization of Cystic Fibrosis Transmembrane Regulator (CFTR) Modulators - Pharmacy Services
01-20-55 A Medical Assistance Bulletin entitled
Prior Authorization of Duchenne Muscular Dystrophy (DMD) Antisense Oligonucleotides - Pharmacy Services
01-20-56 A Medical Assistance Bulletin entitled
Prior Authorization of Evrysdi (risdiplam) - Pharmacy Services
01-20-57 A Medical Assistance Bulletin entitled
Prior Authorization of Palforzia [peanut (Arachis hypogaea) allergen powder] - Pharmacy Services
01-20-58 A Medical Assistance Bulletin entitled
Prior Authorization of Xyrem (sodium oxybate)/Xywav (calcium, magnesium, potassium, and sodium oxybates) - Pharmacy Services
Added Remittance Advice Dates -
January 2021 Remittance Advice Dates
12/02/2020
Added MA Bulletin numbered:
27-20-01 A Medical Assistance Bulletin entitled
Medical Assistance Program Dental Fee Schedule Update
11/24/2020
Added MA Bulletin numbered:
01-20-47 A Medical Assistance Bulletin entitled
Prior Authorization of Cytokine and CAM antagonists - Pharmacy Services
01-20-48 A Medical Assistance Bulletin entitled
Prior Authorization of Tysabri (natalizumab) - Pharmacy Services
Added Managed Care Enrollment Information:
Added
October
2020
11/16/2020
Added MA Bulletin numbered:
01-20-42 A Medical Assistance Bulletin entitled
Prior Authorization of Sickle Cell Agents - Pharmacy Services
01-20-43 A Medical Assistance Bulletin entitled
Statewide Preferred Drug List (PDL) Implementation - Pharmacy Services
01-20-44 A Medical Assistance Bulletin entitled
Prior Authorization of Stimulants and Related Agents - Pharmacy Services
01-20-45 A Medical Assistance Bulletin entitled
Prior Authorization of Synagis (palivizumab) - Pharmacy Services
11/13/2020
Added Remittance Advice Dates -
December 2020 Remittance Advice Dates
Added MA Bulletin numbered:
01-20-38 A Medical Assistance Bulletin entitled
Prior Authorization of Opioid Dependence Treatments - Pharmacy Services
01-20-39 A Medical Assistance Bulletin entitled
Prior Authorization of Pituitary Suppressive Agents, LHRH - Pharmacy Services
01-20-40 A Medical Assistance Bulletin entitled
Prior Authorization of Progestational Agents - Pharmacy Services
01-20-41 A Medical Assistance Bulletin entitled
Prior Authorization of Sedative Hypnotics - Pharmacy Services
11/12/2020
Added MA Bulletin numbered:
99-20-03 A Medical Assistance Bulletin entitled
2020 Recommended Child and Adolescent Immunization Schedule
01-20-33 A Medical Assistance Bulletin entitled
Prior Authorization of Lipotropics, Other - Pharmacy Services
01-20-34 A Medical Assistance Bulletin entitled
Prior Authorization of Migraine Acute Treatment Agents (formerly Antimigraine Agents, Triptans) - Pharmacy Services
01-20-35 A Medical Assistance Bulletin entitled
Prior Authorization of Migraine Prevention Agents (formerly Antimigraine Agents, Other) - Pharmacy Services
01-20-36 A Medical Assistance Bulletin entitled
Prior Authorization of Multiple Sclerosis Agents- Pharmacy Services
01-20-37 A Medical Assistance Bulletin entitled
Prior Authorization of NSAIDs - Pharmacy Services
11/10/2020
Added MA Bulletin numbered:
01-20-26 A Medical Assistance Bulletin entitled
Prior Authorization of HIV/AIDS Antiretrovirals - Pharmacy Services
01-20-27 A Medical Assistance Bulletin entitled
Prior Authorization of Hypoglycemia Treatments - Pharmacy Services
01-20-28 A Medical Assistance Bulletin entitled
Prior Authorization of Hypoglycemics, SGLT2 Inhibitors - Pharmacy Services
01-20-29 A Medical Assistance Bulletin entitled
Prior Authorization of Hypoglycemics, Incretin Mimetics/Enhancers - Pharmacy Services
01-20-30 A Medical Assistance Bulletin entitled
Prior Authorization of Hypoglycemics, TZDs - Pharmacy Services
01-20-31 A Medical Assistance Bulletin entitled
Prior Authorization of Idiopathic Pulmonary Fibrosis (IPF) Agents - Pharmacy Services
01-20-32 A Medical Assistance Bulletin entitled
Prior Authorization of Intra-Articular Hyaluronates - Pharmacy Services
11/09/2020
Added MA Bulletin numbered:
01-20-17 A Medical Assistance Bulletin entitled
Prior Authorization of Androgenic Agents - Pharmacy Services
01-20-18 A Medical Assistance Bulletin entitled
Prior Authorization of Anticonvulsants - Pharmacy Services
01-20-19 A Medical Assistance Bulletin entitled
Prior Authorization of antidepressants, Other - Pharmacy Services
01-20-20 A Medical Assistance Bulletin entitled
Prior Authorization of Anxiolytics - Pharmacy Services
01-20-23 A Medical Assistance Bulletin entitled
Prior Authorization of Hematopoietic Mixtures (Formerly Iron, Oral) - Pharmacy Services
01-20-24 A Medical Assistance Bulletin entitled
Prior Authorization of Hepatitis C Agents - Pharmacy Services
01-20-25 A Medical Assistance Bulletin entitled
Prior Authorization of Hereditary Angioedema (HAE) Agents - Pharmacy Services
11/06/2020
Added MA Bulletin numbered:
01-20-11 A Medical Assistance Bulletin entitled
Prior Authorization of Analgesics, Non-Opioid Barbiturate Combinations - Pharmacy Services
01-20-12 A Medical Assistance Bulletin entitled
Prior Authorization of Analgesics, Opioid Long-Acting - Pharmacy Services
01-20-13 A Medical Assistance Bulletin entitled
Prior Authorization of Analgesics, Opioid Short-Acting - Pharmacy Services
01-20-14 A Medical Assistance Bulletin entitled
Prior Authorization of Bone Density Regulators - Pharmacy Services
01-20-15 A Medical Assistance Bulletin entitled
Prior Authorization of COPD Agents - Pharmacy Services
01-20-16 A Medical Assistance Bulletin entitled
Prior Authorization of Estrogens - Pharmacy Services
01-20-22 A Medical Assistance Bulletin entitled
Prior Authorization of H. Pylori Treatments - Pharmacy Services
10/19/2020
Added Managed Care Enrollment Information.
Added
September
2020
10/15/2020
Added Remittance Advice Dates -
November 2020 Remittance Advice Dates
10/01/2020
Added MA Bulletin numbered:
24-20-02 A Medical Assistance Bulletin entitled
COVID-19 Specimen Collection and Testing at Pharmacies
09/22/2020
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
Added MA Bulletin numbered:
35-20-01 A Medical Assistance Bulletin entitled
School-Based ACCESS Prgram Provider Handbook
09/17/2020
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on September 24, 2020 10:00AM EDT -
Register here
.
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on September 23, 2020 1:00PM EDT -
Register here
.
Added Managed Care Enrollment Information.
Added
August
2020
09/15/2020
Added MA Bulletin numbered:
08-20-03 A Medical Assistance Bulletin entitled
Behavioral Health Group Therapy Provided in Federally Qualified Health Center and Rural Health Clinic Settings
08-20-04 A Medical Assistance Bulletin entitled
Vision Services Provided in Federally Qualified Health Center and Rural Health Clinic Settings
09/11/2020
Added Remittance Advice Dates -
October 2020 Remittance Advice Dates
09/10/2020
Added MA Bulletin numbered:
07-20-04 A Medical Assistance Bulletin entitled
Electronic Visit Verification (EVV) for Personal Care Services (PCS)
09/08/2020
Added MA Bulletin numbered:
01-20-09 A Medical Assistance Bulletin entitled
Specialty Pharmacy Drug Program Preferred Specialty Pharmacy Providers - Pharmacy Services
09/01/2020
Added Managed Care Enrollment Information.
Added
July
2020
08/26/2020
Added MA Bulletin numbered:
05-20-03 A Medical Assistance Bulletin entitled
Electronic Visit Verification for Personal Care Services Provided in the Fee-for-Service Delivery System
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Community Support Service Providers - Federal Financial Participation Rate Change and Continued Billing Requirements
08/14/2020
Added Remittance Advice Dates -
September 2020 Remittance Advice Dates
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #250 -
Version 37.1 of All Patient Refined-Diagnosis Related Group (APR DRG) Implementation
08/12/2020
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Behavioral Health MCO corrections to credits setup erroneously on the cycle 06 RA dated August 10, 2020
07/29/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #251 -
Medical Assistance Benefits for Beneficiaries Turning 21 During the COVID-19 Emergency
07/24/2020
Added Managed Care Enrollment Information.
Added
April
,
May
&
June
2020
07/17/2020
Added Remittance Advice Dates -
August 2020 Remittance Advice Dates
Added Medical Assistance Advisory Committee Meeting minutes, agenda, and attachments - The June 2020 MAAC Webinar Audience Questions have been posted and can be accessed from the
Meeting Minutes
archives page.
07/08/2020
Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on July 23, 2020 10:00AM EDT -
Register here
.
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on July 22, 2020 1:00PM EDT -
Register here
.
07/02/2020
Added MA Bulletin numbered:
01-20-08  A Medical Assistance Bulletin entitled
Addition of Opioid Use Disorder Centers of Excellence Provider Specialty
06/26/2020
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company List for Medicaid Drug Rebate Program
06/24/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #249 -
New MA ACCESS Card
Added MA Bulletin numbered:
99-20-08 A Medical Assistance Bulletin entitled
Update to the Medical Assistance ACCESS ID Card
06/18/2020
Added MA Bulletin numbered:
01-20-04  A Medical Assistance Bulletin entitled
Updates to the Procedures for Presumptive Eligibility as Determined by Hospitals
06/16/2020
Provider's ordering MA Provider Forms Electronically
06/12/2020
Added MA Bulletin numbered:
99-20-07  A Medical Assistance Bulletin entitled
“Payment in Full” and Personal Protective Equipment
06/11/2020
Added MA Bulletin numbered
05-20-02 A Medical Assistance Bulletin entitled
Implementation of Electronic Visit Verification in the FFS and Physical Health Managed Care Delivery Systems
05/27/2020
Added MA Bulletin numbered:
01-20-07  A Medical Assistance Bulletin entitled
Pharmacy Services for Medical Assistance Beneficiaries Related to the COVID-19 Public Health Emergency
05/26/2020
Updated Provider Quick Tip - The following Quick Tip has been added to the website.
Added #207 -
MA Program Fee Schedule Updates for Act 62 Procedure Codes
Added MA Bulletin numbered:
99-20-02 A Medical Assistance Bulletin entitled
2020 Healthcare Common Procedure Coding System (HCPCS) Updates
99-20-04 A Medical Assistance Bulletin entitled
Pennsylvania's Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
01-20-06 A Medical Assistance Bulletin entitled
Updates to Childhood Nutrition and Weight Management Services
05/20/2020
Added MA Bulletin numbered:
99-20-06 A Medical Assistance Bulletin entitled
ICD-10-CM Official Coding Guidelines Related to COVID-19
05/19/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #248 -
DexCom Continuous Glucose Monitoring Products Coverage
05/08/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #247 -
Nonemergency Ambulance Transportation Related to COVID-19
05/07/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #246 -
Rescinding Prior Guidance on Elective Services
05/01/2020
Added MA Bulletin numbered:
09-20-05 A Medical Assistance Bulletin entitled
Home Health Services, Medical Supplies, Equipment and Appliances Prescribed by Non-physician Practitioners
99-20-05  A Medical Assistance Bulletin entitled
COVID-19 Testing and Related Treatment Exempt from MA Copayment Requirements
09-20-06  A Medical Assistance Bulletin entitled
Addition of the Multi-Function Ventilator to the Medical Assistance Program Fee Schedule
01-20-05  A Medical Assistance Bulletin entitled
Addition of Coronavirus Laboratory Test Codes to the MA Program Fee Schedule
04/30/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #245 -
All Patient Refined-Diagnosis Related Group (APR-DRG) to be Updated with COVID-19 Billing Codes
04/17/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #244 -
MA Eligibility During COVID-19 Emergency Disaster Declaration
04/16/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #243 -
Use of the CR Modifier and DR Condition Code for COVID-19 Disaster/Emergency Related Claims
04/09/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #242 -
Telemedicine Guidelines Related to COVID-19
Added #241 -
Prior Authorization Changes in the Medical Assistance Program for Certain Services during COVID0-19 Emergency Disaster
Added #240 -
Provider enrollment and revalidation changes during the COVID-19 emergency
04/07/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #239 -
Short-acting beta agonist metered dose inhalers temporarily added to Statewide Preferred Drug List
Added #238 -
90-Day Supplies of Medications - COVID-19
Added #237 -
Teledentistry Guidelines Related to COVID-19 for Dentists, Federally Qualified Health Centers and Rural Health
04/03/2020
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Added #236 -
Hydroxychloroquine Quantity Limits
12/31/2019
Added MA Bulletin numbered:
99-19-07 A Medical Assistance Bulletin entitled
Place of Service Review and Updates to Surgical Services
12/10/2019
Added MA Bulletin numbered:
01-19-14 A Medical Assistance Bulletin entitled
Billing for Inpatient Hospital and Short Procedure Unit Services When a MA Beneficiary is Directly Admitted from Observation
12/06/2019
Added MA Bulletin numbered:
01-19-100 A Medical Assistance Bulletin entitled
Prior Authorization of Anti-Allergens, Oral-Pharmacy Services
01-19-106 A Medical Assistance Bulletin entitled
Prior Authorization of Antimigraine Agents, Other-Pharmacy Services
01-19-116 A Medical Assistance Bulletin entitled
Prior Authorization of Macular Degeneration Agents - Pharmacy Services
01-19-113 A Medical Assistance Bulletin entitled
Prior Authorization of Pulmonary Arterial Hypertension (PAH) Agents, Oral and Inhaled - Pharmacy Services
01-19-101 A Medical Assistance Bulletin entitled
Prior Authorization of Analgesics, Opioid Short-Acting - Pharmacy Services
01-19-109 A Medical Assistance Bulletin entitled
Prior Authorization of Growth Hormones - Pharmacy Services
01-19-99 A Medical Assistance Bulletin entitled
Prior Authorization of Antibiotics, GI and Related Agents - Pharmacy Services
Added MA Bulletin numbered:
01-19-29 A Medical Assistance Bulletin entitled
Prior Authorization of Vitamin D Analogs – Pharmacy Services
01-19-41 A Medical Assistance Bulletin entitled
Prior Authorization of Thrombopoietics – Pharmacy Services
01-19-31 A Medical Assistance Bulletin entitled
Prior Authorization of Urinary Anti-Infectives – Pharmacy Services
99-19-06 A Medical Assistance Bulletin entitled
Corrected - Diabetes Prevention Program Enrollment in the Medical Assistance Program
01-19-13 A Medical Assistance Bulletin entitled
Family Planning Services Program
01-19-51 A Medical Assistance Bulletin entitled
Prior Authorization of Antihistamines, Minimally Sedating – Pharmacy Services
01-19-50 A Medical Assistance Bulletin entitled
Prior Authorization of Antihyperuricemics – Pharmacy Services
01-19-52 A Medical Assistance Bulletin entitled
Prior Authorization of Antihemophilia Agents – Pharmacy Services
01-19-62 A Medical Assistance Bulletin entitled
Prior Authorization of Intranasal Rhinitis Agents – Pharmacy Services
01-19-49 A Medical Assistance Bulletin entitled
Prior Authorization of Bronchodilators, Beta Agonists – Pharmacy
Services
01-19-53 A Medical Assistance Bulletin entitled
Prior Authorization of Anticoagulants – Pharmacy Services
01-19-58 A Medical Assistance Bulletin entitled
Prior Authorization of GI Motility, Chronic Agents – Pharmacy Services
01-19-54 A Medical Assistance Bulletin entitled
Prior Authorization of Estrogens – Pharmacy Services
01-19-59 A Medical Assistance Bulletin entitled
Prior Authorization of Oncology Agents, Breast Cancer – Pharmacy Services
01-19-61 A Medical Assistance Bulletin entitled
Prior Authorization of Iron Chelating Agents – Pharmacy Services
01-19-60 A Medical Assistance Bulletin entitled
Prior Authorization of Multiple Sclerosis Agents – Pharmacy Services
01-19-55 A Medical Assistance Bulletin entitled
Prior Authorization of Sedative Hypnotics – Pharmacy Services
01-19-57 A Medical Assistance Bulletin entitled
Prior Authorization of Urea Cycle Disorder Agents – Pharmacy Services
01-19-48 A Medical Assistance Bulletin entitled
Prior Authorization of Ulcerative Colitis Agents – Pharmacy Services
01-19-56 A Medical Assistance Bulletin entitled
Prior Authorization of Ophthalmics, Anti-Inflammatories – Pharmacy Services
01-19-64 A Medical Assistance Bulletin entitled
Prior Authorization of Stimulants and Related Agents – Pharmacy Services
01-19-47 A Medical Assistance Bulletin entitled
Prior Authorization of Potassium Removing Agents – Pharmacy Services
01-19-63 A Medical Assistance Bulletin entitled
Prior Authorization of Hypoglycemics, Meglitinides – Pharmacy Services
35-19-01 A Medical Assistance Bulletin entitled
School-Based ACCESS Program Provider Handbook
01-19-21 A Medical Assistance Bulletin entitled Updates to Sterilization Consent Form (MA 31)
01-19-65 A Medical Assistance Bulletin entitled Statewide Preferred Drug List (PDL) Implementation – Pharmacy Services
01-19-79 A Medical Assistance Bulletin entitled Prior Authorization of Glucocorticoids, Inhaled – Pharmacy Services
01-19-94 A Medical Assistance Bulletin entitledPrior Authorization of Antimigraine Agents, Triptans – Pharmacy Services
01-19-84 A Medical Assistance Bulletin entitled Prior Authorization of Blood Glucose Meters and Test Strips (Formerly Diabetic Meters and Diabetic Strips) – Pharmacy Services
01-19-86 A Medical Assistance Bulletin entitled Prior Authorization of Anticonvulsants – Pharmacy Services
01-19-83 A Medical Assistance Bulletin entitled Prior Authorization of Fluoroquinolones, Oral – Pharmacy Services
01-19-97 A Medical Assistance Bulletin entitledPrior Authorization of BPH Treatments – Pharmacy Services
01-19-82 A Medical Assistance Bulletin entitled Prior Authorization of Antifungals, Oral – Pharmacy Services
01-19-85 A Medical Assistance Bulletin entitled Prior Authorization of Antidepressants, SSRIs – Pharmacy Services
01-19-87 A Medical Assistance Bulletin entitled Prior Authorization of Acne Agents, Topical – Pharmacy Services
01-19-88 A Medical Assistance Bulletin entitled Prior Authorization of Antiemetic/Antivertigo Agents – Pharmacy Services
01-19-96 A Medical Assistance Bulletin entitled Prior Authorization of Histamine 2 (H2) Receptor Blockers – Pharmacy Services
01-19-78 A Medical Assistance Bulletin entitled Prior Authorization of Growth Factors – Pharmacy Services
01-19-76 A Medical Assistance Bulletin entitled Prior Authorization of Immunosuppressives, Oral – Pharmacy Services
01-19-81 A Medical Assistance Bulletin entitled Prior Authorization of Intra-Articular Hyaluronates – Pharmacy Services
01-19-77 A Medical Assistance Bulletin entitled Prior Authorization of Idiopathic Pulmonary Fibrosis (IPF) Agents – Pharmacy Services
01-19-72 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Allergic Conjunctivitis (Formerly Ophthalmic Agents for Allergic Conjunctivitis) – Pharmacy Services
01-19-68 A Medical Assistance Bulletin entitledPrior Authorization of Ophthalmics, Immunomodulators (Formerly Ophthalmic Immunomodulators) – Pharmacy Services
01-19-74 A Medical Assistance Bulletin entitled Prior Authorization of Macrolides (Formerly Macrolides/Ketolides) – Pharmacy Services
01-19-75 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Glaucoma (Formerly Ophthalmic Agents for Glaucoma) – Pharmacy Services
01-19-67 A Medical Assistance Bulletin entitledPrior Authorization of Opioid Overdose Agents (Formerly Opiate Overdose Agents) – Pharmacy Services
01-19-71 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Antibiotics (Formerly Ophthalmic Antibiotics) – Pharmacy Services
01-19-95 A Medical Assistance Bulletin entitled Prior Authorization of Iron, Oral - Pharmacy Services
01-19-80 A Medical Assistance Bulletin entitled Prior Authorization of Iron, Parenteral – Pharmacy Services
01-19-70 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Antibiotic-Steroid Combinations (Formerly Ophthalmic Antibiotic-Steroid Combinations) – Pharmacy Services
01-19-73 A Medical Assistance Bulletin entitled Prior Authorization of Neuropathic Pain Agents – Pharmacy Services
01-19-66 A Medical Assistance Bulletin entitled Prior Authorization of Otic Antibiotics (Formerly Otic Antibiotic Preparations) – Pharmacy Services
01-19-93 A Medical Assistance Bulletin entitled Prior Authorization of Proton Pump Inhibitors (PPIs) - Pharmacy Services
01-19-92 A Medical Assistance Bulletin entitled  Prior Authorization of Prenatal Vitamins – Pharmacy Services
27-19-17 A Medical Assistance Bulletin entitled  Medical Assistance Program Dental Fee Schedule and Dental Provider Handbook Update
01-19-90 A Medical Assistance Bulletin entitled Prior Authorization of Steroids, Topical (Formerly Steroids, Topical Low; Steroids, Topical Medium;Steroids, Topical High; and Steroids, Topical Very High) – Pharmacy Services
01-19-91 A Medical Assistance Bulletin entitled Prior Authorization of Tetracyclines – Pharmacy Services
01-19-89 A Medical Assistance Bulletin entitled Prior Authorization of Skeletal Muscle Relaxants – Pharmacy Services
01-19-69 A Medical Assistance Bulletin entitled Prior Authorization of Pancreatic Enzymes – Pharmacy Services
OMHSAS-19-03 A Medical Assistance Bulletin entitled Guidelines for Implementing Assisted Outpatient Treatment
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
Community Support Service Providers - Federal Financial Participation Rate Change and Continued Billing Requirements
Added Remittance Advice Dates
September 2019 Remittance Advice Dates
October 2019 Remittance Advice Dates
November 2019 Remittance Advice Dates
Added Provider Quick Tip - The following Quick Tip has been added to the website.
Updated #11 -
The Eligibility Verification System (EVS)
Added Managed Care Delivery System Subcommittee agenda, draft file note and attachment - The September 2019 Managed Care Delivery System Subcommittee agenda and July  2019 draft file note and attachment have been posted and can be accessed from the
Meeting Minutes
archives page
Added Managed Care Delivery System Subcommittee agenda, draft file note and attachment - The October 2019 Managed Care Delivery System Subcommittee agenda and September 2019 draft file note and attachment have been posted and can be accessed from the
Meeting Minutes
archives page
Added the Fee-for-Service Subcommittee Meeting minutes - The August 2019 Fee-for-Service Subcommittee minutes have been posted and can be accessed from the
Meeting Minutes
archives page.
11/09/2019
Added MA Bulletin numbered:
00-19-03 A Medical Assistance Bulletin entitled Prioritization of Urgency of Need for Services (PUNS) Manual
OMHSAS-19-02 A Medical Assistance Bulletin entitled Service Location Enrollment for Behavioral Health Providers
01-19-37 A Medical Assistance Bulletin entitled Prior Authorization of Antimigraine Agents, Other - Pharmacy Services
01-19-34 A Medical Assistance Bulletin entitled Prior Authorization of Acne Agents, Oral - Pharmacy Services
01-19-39 A Medical Assistance Bulletin entitled Prior Authorization of Antianginal Agents - Pharmacy Services
01-19-38 A Medical Assistance Bulletin entitled Prior Authorization of Antimalarials - Pharmacy Services
01-19-40 A Medical Assistance Bulletin entitled Prior Authorization of Angiotensin Modulators - Pharmacy Services
00-19-12 A Medical Assistance Bulletin entitled Notification Protocol for Formal Licensing Actions and Incidents
OMHSAS-19-03 A Medical Assistance Bulletin entitled Serious Mental Illness: Adult Priority Group
01-19-27 A Medical Assistance Bulletin entitled Prior Authorization of Colony Stimulating Factors - Pharmacy Services
01-19-22 A Medical Assistance Bulletin entitled Prior Authorization of Thalidomide and Derivatives - Pharmacy Services
01-19-26 A Medical Assistance Bulletin entitled Prior Authorization of HIV/AIDS Antiretrovirals - Pharmacy Services
01-19-24 A Medical Assistance Bulletin entitled Prior Authorization of Monoclonal Antibodies - Anti-IL, Anti-lgE (MABs - Anti-IL, anti-IgE) - Pharmacy Services
01-19-28 A Medical Assistance Bulletin entitled Prior Authorization of Cephalosporins - Pharmacy Services
01-19-25 A Medical Assistance Bulletin entitled Prior Authorization of Local Anesthetics, Topical - Pharmacy Services
01-19-23 A Medical Assistance Bulletin entitled Prior Authorization of Penicillins - Pharmacy Services
99-19-02 A Medical Assistance Bulletinentitled Pennsylvania's Early and Periodic screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
99-19-04 A Medical Assistance Bulletin entitled 2019 Healthcare Common Procedure Coding System(HCPCS) Updates, Fee Adjustments and Other Procedure Code Changes
01-19-32 A Medical Assistance Bulletin entitled Prior Authorization of Bone Density Regulators - Pharmacy Services
01-19-35 A Medical Assistance Bulletin entitled Prior Authorization of Antivirals, Herpes - Pharmacy Services
01-19-44 A Medical Assistance Bulletin entitled Prior Authorization of H. Pylori Treatments - Pharmacy Services
01-19-36 A Medical Assistance Bulletin entitled Prior Authorization of Antivirals, CMV - Pharmacy Services
01-19-33 A Medical Assistance Bulletin entitled Prior Authorization of Antivirals, influenza - Pharmacy Services
01-19-42 A Medical Assistance Bulletin entitled Prior Authorization of COPD Agents - Pharmacy Services
01-19-43 A Medical Assistance Bulletin entitled Prior Authorization of Antipsychotics - Pharmacy Services
01-19-30 A Medical Assistance Bulletin entitled Prior Authorization of Vaginal Anti-infectives - Pharmacy
7/18/19
Added MA Bulletin numbered:
01-19-15 A Medical Assistance Bulletin entitled  Prior Authorization of Antibiotics, Inhaled – Pharmacy Services
01-19-16 A Medical Assistance Bulletin entitled  Prior Authorization of Dupixent (dupilumab) – Pharmacy Services
01-19-17 A Medical Assistance Bulletin entitled  Prior Authorization of Immunomodulators, Atopic Dermatitis – Pharmacy
01-19-18 A Medical Assistance Bulletin entitled Prior Authorization of Xyrem (sodium oxybate) – Pharmacy Services
01-19-19 A Medical Assistance Bulletin entitled Prior Authorization of Complement Inhibitors – Pharmacy Services
01-19-20 A Medical Assistance Bulletin entitled Prior Authorization of Calcium Channel Blockers – Pharmacy Services
99-19-13 A Medical Assistance Bulletin entitled Diabetes Prevention Program Enrollment in the Medical Assistance Program
01-19-45 A Medical Assistance Bulletin entitled Medical Marijuana and State Licensure of Facilities and Agencies
01-19-46 A Medical Assistance Bulletin entitled Certified Recovery Specialists in Centers of Excellence
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Revisions to Participating Drug Company List for MA Drug Rebate
Eligibility Verification System Issue
Added Remittance Advice Dates
August 2019 Remittance Advice Dates
Added Managed Care Delivery System Subcommittee Meeting Agenda and Draft File Note - the July 2019 Managed Care Delivery System Subcommittee Agenda and Draft File Note have been posted and can be accessed from the
Meeting Minutes
archives page
6/20/19
Added Provider Quick Tip - The following Quick Tip has been added to the website.
223 - Availability of the Provider Directory on the Department of Human Services Website
Added Medical Assistance Advisory Committee Meeting minutes - The May 2019 Medical Assistance Advisory Committee minutes have been posted and can be accessed from the
Meeting Minutes
archives page.
Added Managed Care Delivery System Subcommittee agenda and draft file note - The June 2019 Managed Care Delivery System Subcommittee agenda and May 2019 draft file note have been posted and can be accessed from the
Meeting Minutes
archives page.
5/23/19
Added Provider Quick Tip - The following Quick Tip has been added to the website.
222 - New Electronic Benefit Transfer Card
Added Medical Assistance Advisory Committee Meeting agenda, minutes and attachments - The May 2019 Medical Assistance Advisory Committee agenda and April 2019 minutes and attachments have been posted and can be accessed from the
Meeting Minutes
archives page.
Added Managed Care Delivery System Subcommittee agenda and draft file note - The May 2019 Managed Care Delivery System Subcommittee agenda and April 2019 draft file note have been posted and can be accessed from the
Meeting Minutes
archives page.
Added the Fee-for-Service Subcommittee Meeting minutes - The May 2019 Fee-for-Service Subcommittee minutes have been posted and can be accessed from the
Meeting Minutes
archives page.
Added Pharmacy and Therapeutics Committee Meeting minutes - The November 2018 Pharmacy and Therapeutic Committee Meeting minutes have been posted and can be accessed from the
Meeting Minutes
archives page.
4/25/19
Added MA Bulletin numbered:
99-19-01 A Medical Assistance Bulletin entitled
2019 Recommended Childhood and Adolescent Immunization Schedule
Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
Date of Death Recovery
ESRD Transitional Drug Adjustment from Medicare
Added Medical Assistance Advisory Committee Meeting agenda, minutes and attachments - The April 2019 Medical Assistance Advisory Committee agenda and March 2019 minutes and attachments have been posted and can be accessed from the
Meeting Minutes
archives page.
4/11/19
Added MA Bulletin numbered:
01-19-11 A Medical Assistance Bulletin entitled
Update to the Administration of the Human Papillomavirus (HPV) Vaccine
Added Remittance Advice Alert - The following Remittance Advice Alert/PROMISe™ Banner page has been added to the website.
Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
Added Provider Quick Tip - The following Quick Tip has been added to the website.
221 - Common Billing Issues Which May Result in Denied Claims as of July 2019
Added Managed Care Delivery System Subcommittee agenda and draft file note - The April 2019 Managed Care Delivery System Subcommittee agenda and March 2019 draft file note have been posted and can be accessed from the
Meeting Minutes
archives page.
3/28/19
Added Remittance Advice Alert - The following Remittance Advice Alert/PROMISe™ Banner page has been added to the website.
Fee-for-Service Relative Weight Adjustments
Added Medical Assistance Advisory Committee Meeting minutes, agenda, and attachments - The December 2018 and January and February 2019 Medical Assistance Advisory Committee minutes and March 2019 agenda and attachments have been posted and can be accessed from the
Meeting Minutes
archives page.
Added Consumer Subcommittee Meeting agenda and attachment - The March 2019 Consumer Subcommittee agenda and attachment have been posted and can be accessed from the
Meeting Minutes
archives page.
Added Drug Utilization Review Board minutes - The September 2018 Drug Utilization Review Board minutes have been posted and can be accessed from the
Meeting Minutes
archives page.
3/14/19
Added MA Bulletin numbered:
01-19-12 A Medical Assistance Bulletin entitled
Changes to Third-Party Liability Requirements for Claims for Prenatal Services
Added Provider Quick Tip - The following Quick Tip has been added to the website.
220 - Version 36 of All Patient Refined-Diagnosis Related Group (APR DRG) Implementation
Added Managed Care Delivery System Subcommittee agenda, draft file note and attachment - The March 2019 Managed Care Delivery System Subcommittee agenda and February 2019 draft file note and attachment have been posted and can be accessed from the
Meeting Minutes
archives page.
2/28/19
Added Remittance Advice Alert - The following Remittance Advice Alert/PROMISe™ Banner page has been added to the website.
Implementation of the All-Patient Refined Diagnosis Related Group version 36
Added Medical Assistance Advisory Committee Meeting agenda - The February 2019 Medical Assistance Advisory Committee agenda has been posted and can be accessed from the
Meeting Minutes
archives page.
Added the Fee-for-Service Subcommittee Meeting minutes - The February 2019 Fee-for-Service Subcommittee minutes have been posted and can be accessed from the
Meeting Minutes
archives page.
Added Managed Care Delivery System Subcommittee agenda and draft file note - The February 2019 Managed Care Delivery System Subcommittee agenda and January 2019 draft file note have been posted and can be accessed from the
Meeting Minutes
archives page.
Added Provider Quick Tips - The following Quick Tips have been added to the website.
219 - Service Location Enrollment Deadline
Added Medical Assistance Advisory Committee Meeting agenda and attachments - The January 2019 Medical Assistance Advisory Committee agenda and attachments have been posted and can be accessed from the
Meeting Minutes
archives page.
1/22/19
Added MA Bulletins numbered:
01-19-02 A Medical Assistance Bulletin entitled
Prior Authorization of Symdeko (tezacaftor/ivacaftor) – Pharmacy Services
01-19-03 A Medical Assistance Bulletin entitled
Prior Authorization of Radicava (edaravone) – Pharmacy Services
01-19-04 A Medical Assistance Bulletin entitled
Preferred Drug List (PDL) Update January 28, 2019 - Pharmacy Services
01-19-05 A Medical Assistance Bulletin entitled
Prior Authorization of Antihyperuricemics – Pharmacy Services
01-19-06 A Medical Assistance Bulletin entitled
Prior Authorization of Anticonvulsants - Pharmacy Services
01-19-07 A Medical Assistance Bulletin entitled
Prior Authorization of Pulmonary Arterial Hypertension (PAH) Agents, Oral and Inhaled – Pharmacy Services
01-19-08 A Medical Assistance Bulletin entitled
Prior Authorization of Alpha-1 Proteinase Inhibitors – Pharmacy Services
01-19-09 A Medical Assistance Bulletin entitled
Prior Authorization of Antiparkinson's Agents – Pharmacy Services
01-19-10 A Medical Assistance Bulletin entitled
Prior Authorization of Multiple Sclerosis Agents – Pharmacy Services
Added Managed Care Delivery System Subcommittee agenda and draft file note - The January 2019 Managed Care Delivery System Subcommittee agenda and December 2018 draft file note have been posted and can be accessed from the
Meeting Minutes
archives page.