Are You Experiencing Denials When Billing Pa. Medicaid MCOs for Health Services?

Last Updated: Feb 2, 2018

As of Jan. 1, 2018, participating providers in a HealthChoices Physical Health Managed Care Organization (MCO) must have a valid Promise Identification number issued by Pennsylvania’s Department of Human Services (DHS) in order to bill for services. 

Here’s what to do if you are receiving billing denials from HealthChoices Physical MCOs:

  1. Consider contacting Provider Relations at each MCO to verify requirements for referencing provider enrollment on each claim.
  2. Next, confirm your billing software/vendor is set up properly for billing due to the enrollment requirement.
  3. Finally, alert your billing department if there is a change in billing requirements to process a clean claim submission to the MCO.

If you have not enrolled or revalidated your status at a Medicaid provider, you will no longer be able to bill a Medicaid MCO for services. Those patients will be reassigned to a new physician.

To verify your service locations and provider or group status, please log on to your Promise account at http://promise.dpw.state.pa.us. Providers are strongly encouraged to verify status and locations as soon as possible.

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

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