As previously communicated, the Pennsylvania Department of Human Services (Department) is implementing the Affordable Care Act provision that requires all providers who render services to Children?s Health Insurance Program (CHIP) members be enrolled with the Department as a CHIP provider by January 1, 2018. Once enrolled, you will be issued a Provider Reimbursement and Operations Management Information System (PROMISe) identification number from the Department. This PROMISe ID is required in order to render services to CHIP members. All providers in the CHIP network need a PROMISe ID for each location in which they see CHIP members. In addition, every provider within a group needs a PROMISe ID for each location. A letter detailing the enrollment process can be found here.
How this affects claims processing
Although there will be no change to our claims processing procedures, please be advised that any claims for services rendered to a CHIP member on or after January 1, 2018, that are submitted to Keystone Health Plan East by a non-enrolled provider (i.e., one without a PROMISe ID) will not receive payment.*
*Look for additional information regarding denials for providers without a PROMISe ID in future Partners in Health UpdateSM articles.
CHIP providers who are already enrolled in the Pennsylvania Medical Assistance (MA) Program do not need to enroll again. However, if providers are enrolled with another state?s Medicaid or CHIP Program, they must enroll with the Department. Although you will be issued a PROMISe ID from the Department upon enrollment, you will not become an MA provider nor will you be required to render services to MA beneficiaries.
The following attachments, as referenced in the letter, are available to assist you with the enrollment process:
- Attachment A: CHIP Provider Types and Specialties for Enrollment
- Attachment B: Provider Types Required to Obtain a Criminal Background Check
- Attachment C: Provider Types Required to Pay the Enrollment Application Fee
- Attachment D: Hardship Exception Request Form
All applications, requirements, and step-by-step instructions are available on the Pennsylvania Department of Human Services website.