Provider Education Resources

Below you will find resources to help you learn more about important processes, procedures and educational tools that will help to make your role easier!

Provider Packet

Electronic Fund Transfer (EFT) - Click here then click on the Electronic Fund Transfer (EFT) tab for the EFT form and general information.”

Electronic Remittance Advice (ERA) - Click here then click the Electronic Remittance Advice (ERA) tab for the ERA form and general information.

Office Ally Clearinghouse - Click here then click the Feb 2017 Claims, Billing, and Reimbursement Notice.

Provider Timely Submission Guide - Click here then click the March 2016 Claims, Billing, and Reimbursement Notice.

FAQs About Provider PROMISe ID Enrollment Revalidation ORP - Click here then click the October 2017 FAQs Notice.

Check PROMISe Enrollment Status - Click here then click the May 2019 Claims, Billing and Reimbursement Notice.

837 I/P Taxonomy Requirement - Click here then click the February 2019 Claims, Billing and Reimbursement Notice.

PROMISe Billing Requirement Reminder - Click here then click the July 2019 Claims, Billing and Reimbursement Notice.

PROMISe ID Enrollment Required at All Service Locations - Click here then click the February 2019 Claims, Billing and Reimbursement Notice.

Required Enrollment of Ordering Referring Prescribing Providers (CHIP) - Click here then click the August 2017 Claims, Billing and Reimbursement Notice.

Required Enrollment of Ordering Referring Prescribing Providers (Medicaid) - Click here then click the August 2017 Claims, Billing and Reimbursement Notice.

Changes to Complaints Grievances and Appeals Process - Click here then click the June 2018 Tools & Resources Notice.

Provider Appeal FormClick here then click the Medical tab.

EPSDT Reference GuideClick here then click the EPSDT tab.

EPSDT Codes and Assessments Wall ChartClick here then click the EPSDT tab.

EPSDT Periodicity Schedule and Coding MatrixClick here then click the EPSDT tab.

Validated Screening Tools for Development Delays and Autism SpectrumClick here then click the EPSDT tab.

Asthma Formulary Update - Click here then click the April 2018 Clinical Coding and Policy Updates Notice.

Pharmacy Web Page

Provider Statewide Preferred Drug List (PDL) FAQ’s - Click here then click the November 2019 FAQ Notice.

Aetna Better Health Special Needs Unit

Cultural Competency Brochure

Pennsylvania’s Telephonic Psychiatric Consultation Service Program - Click here then click on the link under the Attention PCPs – Enroll in TiPS for Your Pediatric Patients tab.

Health Beginnings Plus

Healthcare Effectiveness Data and Information Set (HEDIS) Reference GuideClick here then click the References Guides tab.

Pay for Quality (P4Q) Program Click here then click the References Guides tab.

Special Needs Brochure Click here then click the link.

Online Practitioner Application FormClick here then click the Easily Submit an Online Application tab.

Pharmacy Electronic AuthorizationClick here then click the Electronic Prior Authorization (EPA) tab.

Practitioner Information Change FormClick here then click the Update your Information tab

Prior Authorization Checklist FormClick here then click the Prior Authorization tab.

Prior Authorization Request FormClick here then click the Prior Authorization tab.

Special Needs Unit Case Management Referral FormClick here then click the OBNAF form link under the Medical tab.

Web Portal Registration FormClick here then click the Secure web portal tab.

Portal Information Web PageClick here for the portal registration form, portal access instructions and Quick Tips.”

Provider Manual

Provider Newsletters

Provider Notices

Provider Webinars and Forums

April 28th 2020: Virtual Breakfast Exchange **CANCELLED**

May 13th 2020: Virtual Breakfast Exchange **CANCELLED**

June 2nd 2020: Virtual Breakfast Exchange **CANCELLED**