Notices
Important Provider Updates
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Bulletins
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- January 5, 2023: Reinstatement of MA Provider Enrollment Requirements
- November 22, 2022: COVID-19 Vaccine Counseling Only Under Age 21
- November 22, 2022: COVID 19 Cost Sharing in CHIP
- November 22, 2022: COVID-19 Oral Antiviral Enrollment Form09-26-22
- June 16, 2022: Teledentistry Guidelines and Dental Fee Schedule Updates
- May 16, 2022: Updates to Guidelines for the Delivery of Physical Health Services via Telemedicine
- April 28, 2022: Age Limits for Payment for Administration of the Flucelvax® Quadrivalent Vaccine
- April 22, 2022: Fee Schedule for Personal Care Services
- April 4, 2022: Extension of Postpartum Coverage from 60 days to 12 Months
- March 28, 2022: T1019 Code Additions to MA Fee Schedule for PCS
- March 24, 2022: MenQuadfi® and Vaxelis® Vaccines MAB
- January 19, 2022: Updated Billing Procedures for CRNPs and PAs
- January 3, 2022: Vaccine Administration by Pharmacists
- November 9, 2021: Updated Error Codes for Personal Care Services Subject to EVV
- November 9, 2021: Naloxone Distribution by FQHC/RHCs
- October 4, 2021: Expansion of Telemedicine
- September 28, 2021: Third dose of Sars-Cov-2 vaccine manufactured by Pfizer/Moderna
- September 28, 2021: Home Accessibility DME Procedure for obtaining 1150 waiver
- May 6, 2021: Reinstatement of Prior Authorization Requirements for Certain Services
- March 31, 2021: Restoration of Provider Revalidation Requirements
- January 2021: 2020 Recommended Child and Adolescent Immunization Schedule
- June 2020: Implementation of Electronic Visit Verification
- May 2020: EPSDT Program Periodicity Schedule
- May 2020: Updates to Childhood Nutrition and Weight Management Services
- May 2020: Healthcare Common Procedure Coding System (HCPCS) Updates
- May 2019: Provider Enrollment & Credentialing Application Submission (Individual Providers)
- March 2019: Consultations Performed Using Telemedicine
- August 2018: MAB: Updates to PA’s EPSDT Program Periodicity Schedule
- July 2018: MAB: Enrollment of Tobacco Cessation Providers
- July 2018: MAB: Updates to the Family Planning Services Program Fee Schedule
- July 2018: MAB: 2018 Healthcare Common Procedure Coding System (HCPCS) Updates and Other Procedure Code Changes
- July 2018: MAB: Childhood Nutrition and Weight Management Services
- January2018: DHS Updates to 2017 EPSDT Program Periodicity Schedule
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Claims, Billing and Reimbursement
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- October 2022: New Claim Submission Address Starting December 1st
- March 2022: Update to NDC non fee scheduled reimbursement
- October 2021: Optum Prepay Payment Integrity Program
- August 2021: Submitting Ambulance/Transportation Claims
- April 2021: Diagnosis Requirement for Incontinence Supplies Effective June 1, 2021
- December 2020: 340B Drug Pricing Requirements and Billing Instructions
- October 2020: Avoid Duplicate Rejections on DME, HHC & Hospice Services
- October 2020: Billing Requirements – Rendering/Referring NPI
- October 2020: Refunding of Provider Overpayments
- April 2020: Avoid Duplicate Claims for PT/OT on UB Submissions
- February 2020: Submission of all Encounter Data
- February 2020: APR DRG Version 37 Update
- February 2020: PROMISe ID Service Location Requirement Reminder
- January 2020: Payment Integrity Enhancement
- October 2019: UB-O4 Billing at Ambulatory Surgery Centers
- September 2019: Inpatient Newborn Billing Guidelines
- July 2019: PROMISe Claims Reprocessing Notice
- May 2019: Coventry Claim ID Expired-Use Aetna Claim ID
- May 2019: How to Check Your PROMISe Enrollment Status
- May 2019: Billing Outpatient UB Recovery Room Services
- April 2019: Provider Facility Code Requirement Deadline Approaching
- April 2019: Prenatal Third Party Liability
- March 2019: Intensity Modulated Radiation Therapy Planning Claim Edits
- February 2019: 837 I/P Taxonomy Requirement
- February 2019: APR/DRG Version 36 Update
- February 2019: Ambulance Transport Fee Increase
- February 2019: Emergency Medical Treat/No Transport Payment
- February 2019: PROMISE ID Required for EACH Service Location by July 1, 2019
- February 2019: Correct Claims and Provider Appeals Mailing Addresses
- November 2018: VFC Flu Shortage Notice
- October 2018: New CMS DME Limit effective January 1 2019
- October 2018: 340B Provider Drug Pricing Requirements
- October 2018: Important information regarding paper checks and paper remits
- June 2018: Corrected 835s To Be Released for Some June 12th payments
- April 2018: Provider Facility Code and NPI Required
- March 2018: CPT Code Updates January 1, 2018
- March 2018: Modifier Discounts Updates Effective June 1, 2018
- March 2018: More Frequent Payments Beginning March 7
- March 2018: APR DRG Version 35 Update
- January 2018: RENDERING PROVIDERS MUST BE INDIVIDUALS
- December 2017: New SBIRT Rates Now Covered
- October 2017: Observation Bed Claim Submission Updated October 16, 2017
- August 2017: Required Enrollment of CHIP Ordering, Referring and Prescribing providers
- August 2017: Required Enrollment of Ordering, Referring and Prescribing providers
- June 2017: URGENT PROMISe ID FINAL NOTICE (sic)
- June 2017: Use new HCPCS and CPT-4 codes
- April 2017: Home Nursing Risk Sharing (HNRS) services
- February 2017: APR-DRG Version 34 update effective February 1, 2017
- February 2017: Office Ally - FREE EDI clearinghouse option for providers
- January 2017: LARC family planning billing and reimbursement notice
- January 2017: Claims adjustment and remittance advice code changes
- December 2016: Miscellaneous codes billing guide
- November 2016: Use 5+4 zip codes on claims
- September 2016: Emergency Department policy notice effective November 1, 2016
- July 2016: RHC-FQHC-PPS-FAQ
- May 2016: Cotiviti notice effective June 1, 2016
- March 2016: Timely submission guide
- March 2016: APR-DRG version update
- December 2015: RHC and FQHC billing guidelines
- October 2015: NDC billing requirements for outpatient services
- December 2014: ACA reimbursement change as of 1.1.15
- December 2014: Change to Inpatient Claim Submission Requirements
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Clinical coding and policy updates
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- March 2023: June 1 Cotiviti Policy updates
- February 2023: Coding and Policy Changes
- October 2022: Cotiviti Policy Update
- August 2022: New Implementation Client/Coding Validation
- July 2022: Coordination of Benefits Dental Addition
- June 2022: CHIP Pre Cert Optimization
- April 2022: Change In Prior Auth_PCS_T1019
- January 2022: Skilled Nursing Facility Prior Auth Update
- September 2021: Sterilization Code updates
- September 2021: Coordination of Benefits – Secondary insurance requests
- July 2021: Ultrasound prior auth change
- June 2021: Prior Auth Reinstatement Update
- May 2021: Coding Policy Updates
- April 2021: J-7326 Code Auth Change
- April 2021: Coding Policy Update - Electrophysiology
- February 2021: J Code Prior Auth Changes
- January 2021: Policy Updates, 2 - Effective April 1, 2021
- January 2021: Policy Updates - Effective April 1, 2021
- November 2020: Inpatient Stay Readmission Policy
- October 2020: Bone Debridement Code Updates
- June 2020: Prior Authorization Coding Changes
- April 2020: April 2020: Unlisted CPT and HCPCS Codes
- March 2020: Sterilization Codes Update
- March 2020: Evaluation & Management (E&M) Code Billing Update
- February 2020: Eviti Connect Oncology Decision Support - REVISED
- February 2020: National Drug Code (NDC) Validation Requirements
- January 2020: Code J3145 Auth Change
- January 2020: Retrospective Authorization Review Policy
- December 2019: T code and Prior Authorization Changes
- December 2019: PBM Medical Duplicates
- November 2019: Maternity Bundled Codes HPB
- November 2019: Use of Facility Billing of Revenue Code 0370
- November 2019: Cotiviti Periodic Changes
- October 2019: Diagnosis Restrictions on PCR Testing For Respiratory Viral Panels
- September 2019: Cotiviti Periodic Changes Policy Updates Effective 11/1/2019
- September 2019: Prior Auth Change for Robotic Assisted Surgery
- September 2019: Drugs and Biologics Policy Update Effective 11/1/2019
- July 2019: ICD-10 Policy Reminder
- June 2019: Clinical Coding and Policy Changes Effective August 1, 2019
- April 2019: Opioid Prior Auth Requirements-Phase 3
- March 2019: Clinical Coding and Policy Changes Effective May 1, 2019
- February 2019: HIV Antiretroviral Medications: Diagnosis Confirmation Requirement Effective April 1, 2019
- January 2019: Pharmacy Update: Xgeva/Prolia Steerage
- January 2019: Clinical Coding and Policy Changes Effective March 1, 2019
- December 2018: CLINICAL PAYMENT, CODING AND POLICY CHANGES January 15, 2019
- July 2018: Prior Authorization Coding Updates August 15, 2018
- June 2018: Clinical Payment and Coding Policy Changes July 31, 2018
- April 2018: Asthma Medication Formulary Change
- March 2018: Clinical Payment and Coding Policy Changes
- March 2018: Inpatient Readmission Policy Update March 1, 2018
- March 2018: IVIG Steerage to Pharmacy Effective May 1, 2018
- February 2018: Codes Now Requiring Prior Authorization
- December 2017: Non-OB Ultrasound change effective 12/15/2017
- November 2017: Provider Policy Updates effective 11/28/2017
- September 2017: Provider Policy Updates Effective October 1, 2017
- February 2017: Cross claims policy notice effective May 30, 2017
- September 2016: eviCore cardiology precertification notice effective October 3, 2016
- August 2016: Inpatient stay readmission policy
- August 2015: Jcode prior authorization requirement as of 10.1.15
- July 2015: Observation policy as of 9.1.15
- June 2014: Pain management services
- April 2014: Non-OB ultrasound services
- January 2014: Radiology imaging services
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FAQ's
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- May 2021: EVV Provider FAQ
- November 2019: Statewide Preferred Drug List (PDL) FAQ
- March 2019: Rapid Acting Insulin Change/Conversion Chart/FAQ
- January 2019: FAQ- CHC Eligible Members in a Skilled Nursing Facility
- October 2017: FAQs About Provider Promise ID Enrollment, Revalidation and Ordering, Referring, Prescribing (Orp) Enrollment Processes
- DEC 2016: PCP attestation FAQ
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Tools & Resources
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- April 2023: New EFT/ERA Registration Process
- March 2023: Member ID Numbers are Changing May 1, 2023
- December 2021: Availity to Replace Provider Portal in February
- August 2021: Complaints, Grievance and Appeal address change
- April 2021: Availity Portal Now Available
- November 2020: Aetna Better Health has moved - Get our new address
- January 2019: SKYGEN USA announced as new Dental Benefits Manager
- June 2018: Complaints Grievance & Appeals Updates July 2018
- June 2018: Pharmacy Electronic Prior Authorization (ePA) Notice
- January 2018: HEDIS Webinar Flyer
- December 2017: HEDIS Training Webinar Series
- November 2017: Online Provider Enrollment Application for CHIP Providers now Available
- October 2017: URGENT DHS Training Announcement
- MAY 2017: VFC provider update
- MAY 2017: Enhancement to secure provider web portal
- January 2016: Pro Reports Management Tool
- September 2015: ACA required revalidation all provider types
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Technology Assessment Group Updates
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Check back often to see the technology DHA has reviewed, approved or rejected.
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HealthChoices Updates
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Read the Quick Tips to Learn about the HealthChoices re-procurement. Please note that our Aetna Better Health Kids (CHIP) plan has recently expanded to even more counties and will still be here for members and providers!
Health Choices Reprocurement Provider Quick Tips
HealthChoices Stakeholder Toolkit
Click below for information about Provider Single Case Agreements
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PA Medicaid Closure Process