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.
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 Keystone Health Plan East
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. The Department requires that members are not
billed when claims are rejected due to a provider not having a PROMISe
ID.
How to request 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.
How to confirm the status of your PROMISe
ID
If you submitted your application electronically, you can to check the
status here. You will need to enter the following information:
- application tracking number (ATN)
- social security (SSN) or federal tax identification number (FEIN)
- site password
If you have questions related to this information, please email us
at practiceupdates@ibx.com.