As previously communicated, on January 1, 2018, the Pennsylvania Department of Human Services (Department) implemented 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. Upon enrollment, the Department issues providers a Provider Reimbursement and Operations Management Information System (PROMISe) identification number. This PROMISe ID is required in order to receive payment for services rendered to CHIP members.

Note: All providers in the CHIP network need a PROMISe ID for each location in which they see CHIP members. In addition, every provider who provides services to CHIP members through a group practice needs a PROMISe ID for each location at which they provide services.

Answers to common questions

Some providers have raised questions about the enrollment application fee payable to the Department. The Department has advised that individual providers are not required to pay this fee. The $560.00 application fee applies only to institutional providers such as inpatient facilities, extended care facilities, and durable medical equipment/medical suppliers.

Some providers may have been hesitant to enroll due to the uncertainty regarding the federal reauthorization of CHIP. We are pleased to announce that the CHIP program has been reauthorized for the next 10 years!

Also, remember that enrolling in CHIP does not mean providers must accept Medical Assistance beneficiaries who are not CHIP members.

How this affects claims processing

Please note that claims for services rendered to a CHIP member that are submitted to Keystone Health Plan East by a provider who does not have a PROMISe ID corresponding to the location where the services were rendered may not receive payment in accordance with Department requirements.

Learn more

If you have any questions or issues with the enrollment process, contact the Provider Enrollment Hotline at 1-800-537-8862, select options 3, 1, 1, and finally option 4 to speak to a representative. You can also visit the Pennsylvania Department of Human Services website to access the application, requirements, and step-by-step instructions related to the enrollment process. Providers are encouraged to enroll electronically.