CHIP Providers in Pa. Must Be Enrolled in PROMISe by July 1 to Avoid Claims Denials

Last Updated: Jun 6, 2019

Doc-Child-ArticleClinicians in Pennsylvania must be enrolled with Pennsylvania’s Department of Human Services (DHS) in order to receive payment for services to children covered by the Children’s Health Insurance Program (CHIP).

Effective July 1, 2019, claims for services rendered to a CHIP enrollee that are submitted by a provider who does not have a PROMISe ID that corresponds to the location where the service(s) were rendered will be denied in accordance with DHS requirements.

If you’ve been delaying the decision to enroll or re-enroll as a CHIP provider, here are 3 key points to remember:

  1. CHIP providers are not required to accept Medicaid (known as Medical Assistance in Pennsylvania) beneficiaries.
  2. Physicians and other individual providers are not required to pay an application fee to enroll as a CHIP provider. Only institutional providers such as inpatient facilities, extended care facilities, and CME/medical suppliers are required to pay an application fee.
  3. The CHIP program is not going away any time soon—Congress has reauthorized CHIP through 2027.

How to Enroll as a CHIP Provider

DHS offers enrollment information, including an online application and a paper option, here. Providers are encouraged to enroll online. Keep in mind that each service location must be enrolled separately.

If you have any questions or issues with the enrollment process, contact DHS' Provider Enrollment Hotline at 1-800-537-8862, select options 2, 4 and finally option 2 to speak to a representative.

Pennsylvania Medical Society members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.


2 comments

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  1. Susan Wigger | Apr 03, 2018

    Thank you for your question: DHS’s online PROMISe portal offers a look up tool in ePEAP, an application you can use to verify or make changes to your enrollment status. If you are logged in and looking at the “Active Service Location” page, there is a screen which discloses indicators. There is an indicator if the provider is enrolled in CHIP only. If a provider’s indicator lists “Medical Assistance,” please note that the provider will also be able to accept CHIP patients.

  2. Bonnie Stauffer | Mar 30, 2018
    Is there any place I can go to make sure my providers are enrolled for CHIP.  I have tried going to the individual insurance websites and can not get any help.

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