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DHS Enrollment Required by July 1, 2019

The Pennsylvania Department of Human Services (DHS) released a Medical Assistance Bulletin (#99-18-11, Service Location Enrollment Deadline) at the end of last year and a CHIP Transmittal early this year that requires all providers who render services to Health Partners (Medicaid) members to enroll with DHS as a Medicaid and/or CHIP provider by July 1, 2019. Failure to comply with these new requirements will cause claims to deny. Follow these criteria for enrollment:

  1. Enroll each service location where services are rendered
  2. Enroll as an individual provider
  3. Enroll the provider group 

Next Steps Before July 1, 2019

Follow the steps in the bulletin to enroll with DHS at the service location level as an individual provider and/or group by July 1, 2019. If you have an additional service location or provider at your site that needs to be enrolled, please do so before July 1, 2019.

Submitting a Claim

Any claims for services received for a Health Partners or KidzPartners member on or after July 1, 2019, submitted to HPP by a non-enrolled Health Partners or KidzPartners provider or service location (e.g., a provider and a group without a PROMISe ID) will not receive payment.

Providers must use their National Provider Identifier (NPI) number to submit claims for services. PROMISe uses the NPI number, and when appropriate, the taxonomy and the provider’s nine-digit ZIP code (ZIP + 4) on the claim to identify the provider’s Master Provider Index (MPI) number.

Providers Impacted

This requirement applies to nearly all providers and all services—including emergency room services, except for certain provider types described in the DHS Medical Bulletin—provided to Medicaid and CHIP members.

We appreciate your immediate attention to this compliance issue. If you have any questions, please contact the Provider Services Helpline at 1-888-991-9023 (Monday-Friday, 9 a.m. to 5:30 p.m.).