PA PROMISe Provider Internet User Manual

1 PA PROMISe Provider Internet user Manual SYSTEM DOCUMENTATION LIBRARY REFERENCE NUMBER: [00000164] SECTION: 4-5B LIBRARY REFERENCE NUMBER: [0000082] Provider Internet user Manual REVISION DATE: [04/25/2019] VERSION Provider Internet user Manual PROMISe Internet Portal PA PROMISe System Documentation April 25, 2019 Library Reference Number: [00000082] This data, furnished in connection with this document, shall not be disclosed outside DXC Technology and shall not be duplicated, used, or disclosed in whole or in part. This restriction does not limit the right to use information contained in the document if it is obtained from another source without restriction.

2 Information described in this document is believed to be accurate and reliable, and much care has been taken in its preparation. However, no responsibility, financial or otherwise, is accepted for any consequences arising out of the use or misuse of this material. Address any comments concerning the contents of this Manual to: DXC Technology Attention: Documentation Unit PA MMIS DXC Technology is an equal opportunity employer and values the diversity of its people. 2017 DXC Technology Company. All rights reserved. Provider Internet user Manual PROMISe Internet Portal PA PROMISe System Documentation April 25, 2019 i Revision History Document Version Number Revision Date Revision Page Number(s)

3 Reason for Revisions Revisions Completed By Version 8/6/2010 New Document HP Documentation Team Version 1/1/2012 Updates for 5010 HP Documentation Team Version 2/7/2012 94 Updated Surgical Codes HP Documentation Team Version 4/19/2012 141, 1 Took out Newborn , Changed sentence structure HP Documentation Team Version 8/8/2012 Added Copy function information HP Documentation Team Version 10/4/2012 Updated EVS information HP Documentation Team Version 1/4/2013 Added information relating to NPI processing and new EVS search criterion HP Documentation Team Version 2/4/2013 Updated NPI fields to indicate they re required HP Documentation Team Version 3/6/2013 Updated Portal Login information HP Documentation Team Version 9/20/2013 Integrated ePEAP Manual Added information on Attestation Form HP Documentation Team Version 10/30/2013 Updated per CO 13689 HP

4 Documentation Team Version 12/17/2013 Updated for 14597 HP Documentation Team Version 04/08/2014 Updated for enhancements to the fee schedule HP Documentation Team Provider Internet user Manual PROMISe Internet Portal PA PROMISe System Documentation April 25, 2019 ii Document Version Number Revision Date Revision Page Number(s) Reason for Revisions Revisions Completed By Version 07/03/2014 Updated PO Box on ACN form HP Documentation Team Version 04/22/2015 Updated ACN Form, logo, and Department name HP Documentation Team Version 06/08/2015 Updated ePEAP screens HP Documentation Team Version 07/22/2015 Updated ICN information HP Documentation Team Version 11/06/2015 Updated Registration section.

5 Updated logo and organization from HP to HPE HPE Documentation Team Version 06/01/2016 Updated ePEAP section to include Revalidation Date field HPE Documentation Team Version 12/01/2016 Periodic regeneration HPE Documentation Team Version 05/31/2017 Updated organization name and logo from HPE to DXC Technology; Updated proprietary and copyright statements DXC Documentation Team Version 11/14/2017 Replaced physical address for comments/concerns with email address DXC Documentation Team Version 05/01/2018 Periodic regeneration DXC Documentation Team Version 06/28/2018 Entire Document Updated to include limited DXC Documentation Team Provider Internet user Manual PROMISe Internet Portal PA PROMISe System Documentation April 25, 2019 iii Document Version Number Revision Date Revision Page Number(s)

6 Reason for Revisions Revisions Completed By access for CHIP providers and ePEAP modifications Version 08/03/2018 Updated ERA Enrollment Application window, ePEAP Menu Field Descriptions and ePEAP Manage Remittance Advice sections for Paper Remittance Advice eligibility. DXC Documentation Team Version 8/22/2018 Inserted Section Hospital Assessment windows DXC Documentation Team Version 8/30/2018 Updates to Hospital Assessment screenshots DXC Documentation Team Version 9/18/2018 278 Updated section Layout screenshot and added a new field, Revalidation Date. DXC Documentation Team Version 4/25/2019 Sections: Added section License Expiration pop-up message; Renumbered Claim Submissions to section ; Updated View Specialties references in section 7 DXC Documentation Team Provider Internet user Manual PROMISe Internet Portal PA PROMISe System Documentation April 25, 2019 iv Table of Contents 1 Introduction.

7 1 Key Features and Benefits .. 1 Secured External Web site .. 1 Medical Assistance Providers and Managed Care Organizations .. 2 Windows .. 2 About Field Edits .. 3 Sample Error Message Scenario .. 4 Sample Field Edits Table .. 4 The Menu Bar and other Functions .. 5 The Menu 5 Menu Bar Windows with restricted access for CHIP only Providers/Plans .. 6 Message Layout .. 6 Where Do I Enter My Password? Link .. 7 Logout Link .. 7 Timeout Notifications .. 7 2 Registering for and Logging On to the PROMISe Provider Portal .. 9 Establishing a New Provider user Account .. 10 Process for Registering and Obtaining a Password - Providers.

8 10 Process for Registering and Obtaining a Password Billing Agents .. 14 Process for Registering and Obtaining a Password OON Providers .. 18 About Alternates .. 22 Creating an Alternate .. 22 Adding a New Alternate .. 23 Adding a Registered Alternate .. 26 First Time Access for Alternates Initial Password .. 27 Forgotten Passwords .. 31 Forgot user ID .. 32 Changing a Password .. 33 Denial of Access .. 35 How to Log On To PA PROMISe .. 36 Provider Specialties License Expiry Notification .. 40 Submitting Claims Electronically Using PA PROMISe .. 40 About Dental Claims .. 40 Provider Internet user Manual PROMISe Internet Portal PA PROMISe System Documentation April 25, 2019 v About Institutional Claims.

9 41 About Pharmacy Claims .. 41 About Professional Claims .. 41 About the Copy Function .. 42 3 Enrolling for Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) on the PROMISe Portal .. 43 About the Electronic Funds Transfer Enrollment Application Window .. 43 Layout .. 43 Accessibility and Use .. 44 To Access the Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Enrollment Application Window .. 44 Field Descriptions .. 44 Enrolling for Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) On the PROMISe Portal .. 47 Layout .. 47 Accessibility and Use.

10 48 To Open the Electronic Funds Transfer (EFT) Enrollment Application Window .. 48 To Complete the Electronic Funds Transfer (EFT) Enrollment Application .. 48 Layout (Authorization) .. 53 Field Descriptions .. 53 Electronic Remittance Advice (ERA) Enrollment Application Window .. 57 Layout .. 58 Accessibility and Use .. 58 To Open the Electronic Remittance Advice (ERA) Enrollment Application Window .. 58 Layout (EFT Enrollment Application) .. 59 To Complete the Electronic Remittance Advice (ERA) Enrollment Application .. 60 Layout (Authorization) .. 66 Field Descriptions .. 67 4 Searching for Enrolled Providers on the PROMISe Portal.