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. 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 at which they see CHIP members. In addition, every provider who renders services to CHIP members through a group practice needs a PROMISe ID for each location at which they render 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 ten years!
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.
You can still register for your PROMISe ID!
The deadline for CHIP providers to enroll with the Department was December 31, 2017. However, there is still time to enroll and continue receiving payment for services rendered to CHIP members.
How this affects claims processing
In accordance with Department requirements, providers may not receive payment for claims submitted to Keystone Health Plan East for services rendered to a CHIP member if they do not have a PROMISe ID corresponding to the location where the services were rendered.
Learn more
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 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.