PA PROMISe Provider Internet User Manual

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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: [04/25/2024]

VERSION 5.47

Library Reference Number: [00000082]

Address any comments concerning the contents of this manual to:

Gainwell Technologies

Attention: Documents Unit

PA MMIS

MS 2-200

1250 Camp Hill Bypass, Suite 100

Camp Hill, PA 17077-3700

?2024 Gainwell Technologies Company, All rights reserved.

Revision History

Document

Version

Number

Version 5.6c

Revision

Page

Number(s)

Revision

Date

08/06/2010

Version 5.7

01/01/2012

Version 5.8

02/07/2012

94

Version 5.9

04/19/2012

141,

Updates for 5010

1

Version 5.10 08/08/2012

Version 5.11 10/04/2012

Version 5.12 01/04/2013

Version 5.13 02/04/2013

Version 5.14 03/06/2013

Version 5.15 09/20/2013

Version 5.16 10/30/2013

Version 5.17 12/17/2013

Version 5.18 04/08/2014

Version 5.19 07/03/2014

Reason for

Revisions

New Document

Updated Surgical

Codes

Took out

¡°Newborn¡±,

Changed sentence

structure

Added Copy

function

information

Updated EVS

information

Added information

relating to NPI

processing and new

EVS search

criterion

Updated NPI fields

to indicate they¡¯re

required

Updated Portal

Login information

Integrated ePEAP

Manual

Added information

on Attestation

Form

Updated per CO

13689

Updated for 14597

Updated for

enhancements to

the fee schedule

Updated PO Box

on ACN form

Revisions

Completed By

HP Documentation

Team

HP Documentation

Team

HP Documentation

Team

HP Documentation

Team

HP Documentation

Team

HP Documentation

Team

HP Documentation

Team

HP Documentation

Team

HP Documentation

Team

HP Documentation

Team

HP Documentation

Team

HP Documentation

Team

HP Documentation

Team

HP Documentation

Team

Document

Version

Revision

Number

Date

Version 5.20 04/22/2015

Version 5.21 06/08/2015

Version 5.22 07/22/2015

Version 5.23 11/06/2015

Version 5.24 06/01/2016

Version 5.25 12/01/2016

Version 5.26 05/31/2017

Version 5.27 11/14/2017

Version 5.28 05/01/2018

Revision

Page

Number(s)

Reason for

Revisions

Updated ACN

Form, logo, and

Department name

Updated ePEAP

screens

Updated ICN

information

Updated

Registration

section, updated

logo and

organization from

HP to HPE

Updated ePEAP

section to include

Revalidation Date

field

Periodic

regeneration

Updated

organization name

and logo from HPE

to DXC

Technology;

Updated

proprietary and

copyright

statements

Replaced physical

address for

comments/concerns

with email address

Periodic

regeneration

Revisions

Completed By

HP Documentation

Team

HP Documentation

Team

HP Documentation

Team

HPE

Documentation

Team

HPE

Documentation

Team

HPE

Documentation

Team

DXC

Documentation

Team

DXC

Documentation

Team

DXC

Documentation

Team

Document

Version

Revision

Number

Date

Version 5.29 06/28/2018

Revision

Page

Number(s)

Entire

Document

Version 5.30 08/03/2018

Version 5.31 08/22/2018

Version 5.32 08/30/2018

Version 5.33 09/18/2018

278

Reason for

Revisions

Updated to include

limited access for

CHIP providers

and ePEAP

modifications

Updated ERA

Enrollment

Application

window, ePEAP

Menu Field

Descriptions and

ePEAP Manage

Remittance Advice

sections for Paper

Remittance Advice

eligibility.

Inserted Section

7.43 Hospital

Assessment

windows

Updates to Hospital

Assessment

screenshots

Updated section

7.40 Layout

screenshot and

added a new field,

Revalidation Date.

Revisions

Completed By

DXC

Documentation

Team

DXC

Documentation

Team

DXC

Documentation

Team

DXC

Documentation

Team

DXC

Documentation

Team

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