PA PROMISe Provider Internet User Manual

PA PROMISeTM 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 5.34

PROMISeTM Internet Portal

Provider Internet User Manual PA PROMISeTM System Documentation

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.

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

promisedocumentationtm@

DXC Technology is an equal opportunity employer and values the diversity of its people. ? 2017 DXC Technology Company. All rights reserved.

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Revision History

Document Version Number Version 5.6c

Revision Date 8/6/2010

Version 5.7 1/1/2012

Version 5.8 2/7/2012

Version 5.9 4/19/2012

Version 5.10 8/8/2012

Version 5.11 10/4/2012 Version 5.12 1/4/2013

Version 5.13 2/4/2013 Version 5.14 3/6/2013 Version 5.15 9/20/2013

Revision Page Number(s)

94 141, 1

Reason for Revisions New Document

Updates for 5010

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

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

Version 5.16 10/30/2013 Version 5.17 12/17/2013 Version 5.18 04/08/2014

Added information on Attestation Form Updated per CO 13689 Updated for 14597 Updated for enhancements to the fee schedule

HP Documentation Team HP Documentation Team HP Documentation Team

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Document Version Number

Revision Date

Revision

Page

Reason for

Number(s) Revisions

Revisions Completed By

Version 5.19 07/03/2014 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 Version 5.29 06/28/2018

Entire Document

Updated PO Box on ACN form 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/concer ns with email address Periodic regeneration Updated to include limited

HP Documentation Team 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 DXC Documentation Team

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Document Version Number

Revision Date

Version 5.30 08/03/2018

Version 5.31 8/22/2018 Version 5.32 8/30/2018 Version 5.33 9/18/2018

Version 5.34 4/25/2019

Revision Page Number(s)

278

Sections: 2.11 2.12 7.36.2 7.37.2 7.37.3 7.41.2

Reason for Revisions 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.

Added section 2.11 License Expiration pop-up message; Renumbered Claim Submissions to section 2.12; Updated View Specialties references in section 7

Revisions Completed By

DXC Documentation Team

DXC Documentation Team DXC Documentation Team DXC Documentation Team

DXC Documentation Team

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Table of Contents

1 Introduction........................................................................................................................... 1

1.1

Key Features and Benefits .......................................................................................... 1

1.2

Secured External Web site .......................................................................................... 1

1.3

Medical Assistance Providers and Managed Care Organizations .............................. 2

1.4

Windows ..................................................................................................................... 2

1.5

About Field Edits ........................................................................................................ 3

1.5.1 Sample Error Message Scenario.............................................................................................. 4 1.5.2 Sample Field Edits Table ........................................................................................................ 4

1.6

The Menu Bar and other Functions ............................................................................ 5

1.6.1 1.6.2 1.6.3

The Menu Bar.......................................................................................................................... 5 Menu Bar Windows with restricted access for CHIP only Providers/Plans............................ 6 Message Layout....................................................................................................................... 6

1.7

Where Do I Enter My Password? Link....................................................................... 7

1.7.1 Logout Link............................................................................................................................. 7

1.8

Timeout Notifications ................................................................................................. 7

2 Registering for and Logging On to the PROMISeTM Provider Portal ............................. 9

2.1

Establishing a New Provider User Account.............................................................. 10

2.2

Process for Registering and Obtaining a Password - Providers................................ 10

2.3

Process for Registering and Obtaining a Password ? Billing Agents ....................... 14

2.4

Process for Registering and Obtaining a Password ? OON Providers ..................... 18

2.5

About Alternates ....................................................................................................... 22

2.5.1 2.5.2 2.5.3 2.5.4

Creating an Alternate ............................................................................................................ 22 Adding a New Alternate........................................................................................................ 23 Adding a Registered Alternate .............................................................................................. 26 First Time Access for Alternates ? Initial Password ............................................................. 27

2.6

Forgotten Passwords ................................................................................................. 31

2.7

Forgot User ID .......................................................................................................... 32

2.8

Changing a Password ................................................................................................ 33

2.9

Denial of Access ....................................................................................................... 35

2.10 How to Log On To PA PROMISeTM.......................................................................... 36

2.11 Provider Specialties License Expiry Notification ..................................................... 40

2.12 Submitting Claims Electronically Using PA PROMISeTM ........................................ 40

2.12.1 About Dental Claims ............................................................................................................. 40

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2.12.2 About Institutional Claims .................................................................................................... 41 2.12.3 About Pharmacy Claims........................................................................................................ 41 2.12.4 About Professional Claims .................................................................................................... 41 2.12.5 About the Copy Function ...................................................................................................... 42

3 Enrolling for Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) on the PROMISeTM Portal ............................................................................................. 43

3.1

About the Electronic Funds Transfer Enrollment Application Window .................. 43

3.1.1 Layout ................................................................................................................................... 43 3.1.2 Accessibility and Use ............................................................................................................ 44

To Access the Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Enrollment Application Window.............................................................................................. 44 3.1.3 Field Descriptions ................................................................................................................. 44

3.2

Enrolling for Electronic Funds Transfer (EFT) and Electronic Remittance Advice

(ERA) On the PROMISeTM Portal ............................................................................................. 47

3.2.1 Layout ................................................................................................................................... 47 3.2.2 Accessibility and Use ............................................................................................................ 48

To Open the Electronic Funds Transfer (EFT) Enrollment Application Window ................... 48 To Complete the Electronic Funds Transfer (EFT) Enrollment Application ........................... 48 3.2.3 Layout (Authorization).......................................................................................................... 53 3.2.4 Field Descriptions ................................................................................................................. 53

3.3

Electronic Remittance Advice (ERA) Enrollment Application Window ................. 57

3.3.1 Layout ................................................................................................................................... 58 3.3.2 Accessibility and Use ............................................................................................................ 58

To Open the Electronic Remittance Advice (ERA) Enrollment Application Window ............ 58 3.3.3 Layout (EFT Enrollment Application) .................................................................................. 59

To Complete the Electronic Remittance Advice (ERA) Enrollment Application .................... 60 3.3.4 Layout (Authorization).......................................................................................................... 66 3.3.5 Field Descriptions ................................................................................................................. 67

4 Searching for Enrolled Providers on the PROMISeTM Portal........................................ 72

4.1

About the Enrolled Provider Search Window........................................................... 72

4.2

First Date of Service Search Criteria ........................................................................ 72

4.3

Provider Search Results for Medical Assistance Provider Inquiry........................... 72

4.4

Provider Search Results for CHIP Provider/Plan Inquiry......................................... 72

4.5

List of Active Providers that a Medical Assistance Provider can Download ........... 72

4.6

List of Active Providers that a CHIP Provider/Plan can Download ......................... 73

4.6.1 4.6.2 4.6.3

Layout ................................................................................................................................... 73 Accessibility and Use ............................................................................................................ 74 Field Descriptions ................................................................................................................. 74

5 Claim Inquiries.................................................................................................................... 76

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5.1

About Internal Control Numbers (ICNs) .................................................................. 76

5.2

Using the Provider Claim Inquiry Window .............................................................. 76

5.2.1 Layout ................................................................................................................................... 77

To Search for a Claim by Recipient ID .................................................................................... 77 To Search for a Claim by Patient Account Number ................................................................. 77 To Search for a Claim by ICN .................................................................................................. 78 To View Recipient Eligibility................................................................................................... 78 To Submit a Claim Adjustment ................................................................................................ 78

5.3

Recipient Eligibility Verification.............................................................................. 79

5.3.1 Layout ................................................................................................................................... 80

6 Provider Reports ................................................................................................................. 82

6.1

About the Provider Report Index Window ............................................................... 82

6.1.1 Layout ................................................................................................................................... 82

7 PA PROMISeTM Internet Windows .................................................................................. 83

7.1

My Profile (My Profile) ............................................................................................ 83

7.1.1 Layout ................................................................................................................................... 84 7.1.2 Field Descriptions ................................................................................................................. 84 7.1.3 Field Edits ............................................................................................................................. 84 7.1.4 Accessibility and Use ............................................................................................................ 85

To Access My Profile Window ................................................................................................ 85

7.2

Alternate No Access (Alternate No Access)............................................................. 85

7.2.1 7.2.2 7.2.3

Layout ................................................................................................................................... 85 Field Descriptions ................................................................................................................. 86 Field Edits ............................................................................................................................. 86

7.3

Billing Agent No Access (Billing Agent No Access)............................................... 86

7.3.1 7.3.2 7.3.3

Layout ................................................................................................................................... 86 Field Descriptions ................................................................................................................. 87 Field Edits ............................................................................................................................. 87

7.4

File Download (File Download) ............................................................................... 87

7.4.1 Layout ................................................................................................................................... 87 7.4.2 Field Descriptions ................................................................................................................. 88 7.4.3 Field Edits ............................................................................................................................. 88 7.4.4 Accessibility and Use ............................................................................................................ 88

To Access File Download Window .......................................................................................... 88 To View Downloaded File Information.................................................................................... 88

7.5

Provider Claim Attachment Number Request (Provider Claim Attachment Number

Request) 88

7.5.1 Layout ................................................................................................................................... 89 7.5.2 Field Descriptions ................................................................................................................. 91

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