Over the past several months, we have published articles in Partners in Health UpdateSM informing you that the Pennsylvania Department of Human Services (Department) requires all providers in the Children’s Health Insurance Program (CHIP) network to have a PROMISe ID for each location at which they treat CHIP members. A PROMISe ID is a Department-issued Provider Reimbursement and Operations Management Information System (PROMISe) identification number. It is required for you to receive payment for services rendered to CHIP members.
Deadline approaching
In accordance with Department requirements all claims submitted for Independence CHIP members for dates of service on or after July 1, 2019, by an in-network provider who does not have a PROMISe ID that corresponds to the location where the services were rendered, or through which services were ordered, referred, or billed, will be denied. Please be aware that both the practitioner and the group/provider need a PROMISe ID for the claims to process.
Continuity of care
Continuity of care options will be available for 60 days for CHIP members who are in an active course of treatment with a physician or provider who does not have a PROMISe ID. Requests for exceptions will be considered when there is an ongoing, active course of treatment for a chronic or acute medical condition and prudent medical practice requires continued care from the same physician. Please be mindful that your contract with Independence limits when providers can bill members for non-covered services other than copayments, coinsurance, and deductibles.
How to request or verify a PROMISe ID
Visit the Department’s website to access the application, requirements, and step-by-step instructions related to the enrollment process. If you have any questions or issues with the enrollment process, contact the Department’s Provider Enrollment Hotline at 1-800-537-8862, select options 2, 4, and finally option 2 to speak to a Department representative. The application and hotline are monitored by the Pennsylvania Department of Human Services, not Independence.
If you have questions related to this information, please email us at practiceupdates@ibx.com.