​What's New at OMAP

03/25/2025

Added Managed Care Enrollment Information:

• February 2025

03/19/2025

• Updated Pennsylvania Medicaid Managed Care Directory

03/18/2025

Added Remittance Advice Dates – April 2025 Remittance Advice Date

03/12/2025

• Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.
  • Revisions to Participating Drug Company list for Medicaid Drug Rebate Program

02/27/2025

• Updated Provider Quick Tip #121 - Certification Renewal Required for Medical Assistance (MA) Providers Dispensing Hearing Aid Supplies (revised February 2025)
• Updated Provider Quick Tip #176 - Presumptive Eligibility for Pregnant Women - 2025 Income Limits
   

• Updated Pennsylvania Medicaid Managed Care Directory

Added Managed Care Enrollment Information:

• January 2025

02/18/2025

Added MA Bulletins numbered:

• 01-25-34 A Medical Assistance Bulletin entitled: Screening, Diagnostic, and Targeted Case Management Services for Eligible Juveniles Enrolled in Medical Assistance Prior to Release from a Carceral Setting

Added Remittance Advice Dates – March 2025 Remittance Advice Date

01/28/2025

Added PROMISe Provider Handbooks and Billing Guides Information:

• Updated 837 Professional / CMS-1500 Claim Form
   

01/22/2025

Added Remittance Advice Dates – February 2025 Remittance Advice Date

01/21/2025

Added Managed Care Enrollment Information:

• December 2024

01/16/2025

Added MA Bulletins numbered:

• 99-25-01 A Medical Assistance Bulletin entitled: Limited English Proficiency Requirements

01/10/2025

Added MA Bulletins numbered:

• 01-25-33 A Medical Assistance Bulletin entitled: Prior Authorization of Anticonvulsants - Pharmacy Services
• 03-25-33 A Medical Assistance Bulletin entitled: Update to the Admissions Notice Packet (MA 401)

01/02/2025

Added Managed Care Enrollment Information:

•  November 2024

12/30/2022

Added Provider Quick Tips - The following Quick Tips have been added to the website.

• Updated #41 - Medical Assistance Desk Reference (updated December 2022)

 

12/29/2022

Added MA Bulletin numbered:

• 99-22-11 A Medical Assistance Bulletin entitled Reinstatement of Provider Enrollment Requirements

12/23/2022

Added the updated Pennsylvania Medicaid Managed Care Directory

12/22/2022

Added MA Bulletin numbered:

• 01-22-78 A Medical Assistance Bulletin entitled 340B Drug Pricing Program - Dispensing 340B Purchased Drugs

12/19/2022

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Revisions to Participating Drug Company list for Medicaid Drug Rebate Program

12/16/2022

Added Remittance Advice Dates - January 2023 Remittance Advice Dates

12/13/2022

Added MA Bulletin numbered:

• 01-22-63 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, Incretin Mimetics/Enhancers – Pharmacy Services
  
• 05-22-14 A Medical Assistance Bulletin entitled Disposable Breast Milk Collection and Storage Bags and Breast Pump
  

12/09/2022

Added MA Bulletin numbered:

• 01-22-50 A Medical Assistance Bulletin entitled Prior Authorization of Monoclonal Antibodies - Anti-IL, Anti-IgE, Anti-TSLP (Formerly Monoclonal Antibodies - Anti-IL, Anti-IgE) - Pharmacy Services
  
• 01-22-75 A Medical Assistance Bulletin entitled Statewide Preferred Drug List (PDL) Updates - Pharmacy Services
  
• 01-22-70 A Medical Assistance Bulletin entitled Coverage and Prior Authorization of Obesity Treatment Agents - Pharmacy Services
  

12/08/2022

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Updated - #256 - Procedure Code/Modifier Combinations to be Utilized When Requesting Home Accessibility Durable Medical Equipment (DME) and DME Repairs in the Fee-for-Service Delivery System (revised December 2022)
  
  

Added MA Bulletin numbered:

• 01-22-73 A Medical Assistance Bulletin entitled Prior Authorization of Platelet Aggregation Inhibitors - Pharmacy Services
  
• 01-22-65 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, SGLT2 Inhibitors - Pharmacy Services
  
• 01-22-72 A Medical Assistance Bulletin entitled Prior Authorization of Pituitary Suppressive Agents, LHRH - Pharmacy Services
  
• 01-22-71 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Anti-Inflammatories - Pharmacy Services
  

12/07/2022

Added MA Bulletin numbered:

• 01-22-68 A Medical Assistance Bulletin entitled Prior Authorization of Lipotropics, Other - Pharmacy Services
  
• 01-22-74 A Medical Assistance Bulletin entitled Prior Authorization of Stimulants and Related Agents - Pharmacy Services
  

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Updated -  #264 – Electronic Visit Verification
  

 

Added Managed Care Enrollment Information:

• Added September 2022 and October2022
  
  

12/02/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added - #264 – Electronic Visit Verification
  

11/10/2022

Added MA Bulletin numbered:

• 26-22-07 A Medical Assistance Bulletin entitled 2023 Ambulance Fee Increases
  
• 24-22-32 A Medical Assistance Bulletin entitled At-Home Over-The-Counter COVID-19 Tests
  
• 01-22-57 A Medical Assistance Bulletin entitled Prior Authorization of Dry Eye Treatments (Formerly Ophthalmics, Immunomodulators) - Pharmacy Services
  
• 01-22-64 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, Insulin and Related Agents - Pharmacy Services
  
• 01-22-66 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, TZDs - Pharmacy Services
  
• 01-22-67 A Medical Assistance Bulletin entitled Prior Authorization of Immunomodulators, Atopic Dermatitis - Pharmacy Services
  
• 01-22-69 A Medical Assistance Bulletin entitled Prior Authorization of NSAIDs - Pharmacy Services
  

11/09/2022

Added MA Bulletin numbered:

• 01-22-60 A Medical Assistance Bulletin entitled Prior Authorization of Glucocorticoids, Inhaled - Pharmacy Services
  
• 01-22-61 A Medical Assistance Bulletin entitled Prior Authorization of Glucocorticoids, Oral - Pharmacy Services
  
• 01-22-62 A Medical Assistance Bulletin entitled Prior Authorization of Hepatitis C Agents - Pharmacy Services
  
• 01-22-49 A Medical Assistance Bulletin entitled Prior Authorization of Antihemophilia Agents - Pharmacy Services
  
• 01-22-45 A Medical Assistance Bulletin entitled Prior Authorization of Angiotensin Modulator Combinations - Pharmacy Services
  
• 01-22-54 A Medical Assistance Bulletin entitled Prior Authorization of Bile Salts - Pharmacy Services
  
• 01-22-56 A Medical Assistance Bulletin entitled Prior Authorization of Cytokine and CAM Antagonists - Pharmacy Services
  

11/08/2022

Added MA Bulletin numbered:

• 01-22-47 A Medical Assistance Bulletin entitled Prior Authorization of Antibiotics, GI and Related Agents - Pharmacy Services
  
• 01-22-48 A Medical Assistance Bulletin entitled Prior Authorization of Antifibrotic Respiratory Agents (Formerly Idiopathic Pulmonary Fibrosis (IPF) Agents) - Pharmacy Services
  
• 01-22-52 A Medical Assistance Bulletin entitled Prior Authorization of Antipsychotics - Pharmacy Services
  
• 01-22-53 A Medical Assistance Bulletin entitled Prior Authorization of Antivirals, CMV - Pharmacy Services
  
• 01-22-55 A Medical Assistance Bulletin entitled Prior Authorization of Corticotropin (formerly H.P. Acthar Gel) - Pharmacy Services
  
• 01-22-58 A Medical Assistance Bulletin entitled Prior Authorization of Dupixent (dupilumab) - Pharmacy Services
  
• 01-22-59 A Medical Assistance Bulletin entitled Prior Authorization of GI Motility, Chronic Agents - Pharmacy Services
  

11/04/2022

Added the updated Pennsylvania Medicaid Managed Care Directory

Added MA Bulletin numbered:

• 01-22-43 A Medical Assistance Bulletin entitled Prior Authorization of Acne Agents, Oral - Pharmacy Services
  
• 01-22-44 A Medical Assistance Bulletin entitled Prior Authorization of Alcohol Use Disorder Agents – Pharmacy Services
  
• 01-22-46 A Medical Assistance Bulletin entitled Prior Authorization of Antianginal Agents - Pharmacy Services
  
• 01-22-51 A Medical Assistance Bulletin entitled Prior Authorization of Antipsoriatics, Topical - Pharmacy Services
  
• 99-22-10 A Medical Assistance Bulletin entitled Enrollment of Providers for Medicare Cost-Sharing Only
  

11/03/2022

Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on December 7th, 2022 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on December 8th, 2022 at 10:00AM EDT - Register here.

11/02/2022

Added Remittance Advice Dates - December 2022 Remittance Advice Dates

10/17/2022

Added MA Bulletin numbered:

• 01-22-18 Medical Assistance Bulletin entitled -   SARS-CoV-2 Vaccine Booster Manufactured by Moderna, Inc.
  

Added Remittance Advice Dates - November 2022 Remittance Advice Dates

10/07/2022
Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #263 - 180 Day Electronic Process
  
  

Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on October 13, 2022 at 10:00AM EDT - Register here.

Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on October 26, 2022 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on October 27, 2022 at 10:00AM EDT - Register here.

09/29/2022

Added Managed Care Enrollment Information:

• Added August 2022

09/28/2022
Added MA Bulletin numbered:

• 01-22-39 Medical Assistance Bulletin entitled -   Updates to Pediatric SARS-CoV-2 Vaccines Manufactured by Pfizer, Inc. and Moderna, Inc.
  

09/26/2022
Added MA Bulletin numbered:

• 05-22-08 Medical Assistance Bulletin entitled -   Additions to the Medical Assistance Fee Schedule for Private Duty Nursing Services Provided to Beneficiaries Under the Age of 21.  
  
  

09/23/2022
Added MA Bulletin numbered:

• 01-22-12 Medical Assistance Bulletin entitled -   COVID-19 Vaccine Counseling Only Visits for Beneficiaries Under 21
  

09/22/2022

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Updated #260 - Provider Electronic Portal Update
  

09/20/2022
Added MA Bulletin numbered:

• 01-22-14 Medical Assistance Bulletin entitled -   Vaccine Counseling Only Visits for Beneficiaries Under 21
  

09/19/2022
Added MA Bulletin numbered:

• 01-22-38 Medical Assistance Bulletin entitled -   Administration of SARS-CoV-2 Vaccine Manufactured by Novavax
• 99-22-07 Medical Assistance Bulletin entitled -   Pennsylvania’s Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
  
  

Added the updated Pennsylvania Medicaid Managed Care Directory

09/16/2022

Added Remittance Advice Dates - October 2022 Remittance Advice Dates

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Provider Enrollment Summary Enhancements

09/15/2022
Added MA Bulletin numbered:

• 35-22-02 Medical Assistance Bulletin entitled -   School-Based ACCESS Program Provider Handbook
  

09/14/2022
Added MA Bulletin numbered:

• 01-22-42 Medical Assistance Bulletin entitled -   Adult Vaccine Procedure Code Updates and Additions
  

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Revisions to Participating Drug Company list for Medicaid Drug Rebate Program

 

09/13/2022

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Updated #262 - Provider Enrollment Summary Enhancements
  

09/12/2022

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Delay in Hospice Rates for FY 2023

09/09/2022

Added the updated Pennsylvania Medicaid Managed Care Directory

09/07/2022
Added MA Bulletin numbered:

• 27-22-27 Medical Assistance Bulletin entitled -   2022 Medical Assistance Program Dental Fee Schedule Update
  

09/06/2022

Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on September 8, 2022 at 10:00AM EDT - Register here.

09/02/2022

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Corrections to Cycle 07 & 66 Credits (Accounts Receivables) recoupments
• Community Support Service Providers - Federal Financial Participation Rate Change and Continued Billing Requirements
• Provider Enrollment Summary Enhancements

09/01/2022

Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on September 21, 2022 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on September 22, 2022 at 10:00AM EDT - Register here.

Added Managed Care Enrollment Information:

• Added July 2022
  
  

08/29/2022
Added MA Bulletin numbered:

• 08-22-19 Medical Assistance Bulletin entitled -   Naloxone Distribution by Federally Qualified Health Centers and Rural Health Clinics
• 01-22-41 Medical Assistance Bulletin entitled - Additions to the Medical Assistance Fee Schedule for Monkeypox Laboratory Testing and Vaccines

08/26/2022
Added MA Bulletin numbered:

• 08-22-44 Medical Assistance Bulletin entitled -   Addition of Behavioral Health Providers to Certain Procedure Codesand other Procedure Code Changes 
• 99-22-05 Medical Assistance Bulletin entitled - 2022 Healthcare Common Procedure Coding System (HCPCS) Updates and Other Procedure Code Changes 
• 01-22-15 Medical Assistance Bulletin entitled - Adult Vaccine Procedure Code Updates and Additions - OBSOLETE
  

08/19/2022

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Date of Death Recovery

08/16/2022

Added Remittance Advice Dates - September 2022 Remittance Advice Dates

Added Remittance Advice Alert - The following Remittance Advice Alert/PROMISe™ Banner page has been added to the website.

• Financial Cycle 66 Continuation of Financial Cycle 07
  

08/10/2022
Added MA Bulletin numbered:

• 05-22-09 Medical Assistance Bulletin entitled - Electronic Visit Verification Requirements for Home Health Care Services in the Fee-for-Service Delivery and Managed Care Delivery Systems

08/01/2022
Added Managed Care Enrollment Information:

• Added May 2022 and June 2022

07/29/2022
Added Managed Care Enrollment Information:

• Added April 2022

07/26/2022

Added Remittance Advice Dates - August 2022 Remittance Advice Dates

07/14/2022

Added MA Bulletin numbered:

• 01-22-26 Medical Assistance Bulletin entitled - Prior Authorization of Epinephrine, Self-Injected - Pharmacy Services
• 01-22-28 Medical Assistance Bulletin entitled - Prior Authorization of Hypoglycemics, Alpha Glucosidase Inhibitors - Pharmacy Services
  
• 01-22-29 Medical Assistance Bulletin entitled - Prior Authorization of Hypoglycemics, Metformins - Pharmacy Services

07/13/2022

Added MA Bulletin numbered:

• 01-22-24 Medical Assistance Bulletin entitled - Prior Authorization of Contraceptives, Oral - Pharmacy Services
• 01-22-25 Medical Assistance Bulletin entitled - Prior Authorization of Contraceptives, Other - Pharmacy Services
  
• 01-22-19 Medical Assistance Bulletin entitled - Prior Authorization of Acne Agents, Topical - Pharmacy Services
• 01-22-27 Medical Assistance Bulletin entitled - Prior Authorization of Hepatitis B Agents - Pharmacy Services

07/11/2022

Added MA Bulletin numbered:

• 01-22-23 Medical Assistance Bulletin entitled - Prior Authorization of Antipsoriatics, Oral - Pharmacy Services
  
• 01-22-22 Medical Assistance Bulletin entitled - Prior Authorization of Antiparkinson’s Agents - Pharmacy Services
  
• 01-22-21 Medical Assistance Bulletin entitled - Prior Authorization of Antihypertensives, Sympatholytic - Pharmacy Services
• 01-22-20 Medical Assistance Bulletin entitled - Prior Authorization of Antibiotics, Topical - Pharmacy Services

07/08/2022

Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on July 14, 2022 at 10:00AM EDT - Register here.

Added MA Bulletin numbered:

• 01-22-31 Medical Assistance Bulletin entitled - Prior Authorization of Immunomodulators, Topical – Pharmacy Services
• 01-22-30 Medical Assistance Bulletin entitled - Prior Authorization of Hypoglycemics, Sulfonylureas – Pharmacy Services

Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on July 27, 2022 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on July 28, 2022 at 10:00AM EDT - Register here.

07/07/2022

Added MA Bulletin numbered:

• 01-22-33 Medical Assistance Bulletin entitled - Prior Authorization of Lipotropics, Statins – Pharmacy Services.
  
• 01-22-32 Medical Assistance Bulletin entitled - Prior Authorization of Leukotriene Modifiers – Pharmacy Services.
  

07/06/2022

Added MA Bulletin numbered:

• 09-22-37 Medical Assistance Bulletin entitled - Disposable Surgical Masks.
  
• 01-22-35 Medical Assistance Bulletin entitled - Prior Authorization of Phosphate Binders - Pharmacy Services.
  
• 01-22-34 Medical Assistance Bulletin entitled - Prior Authorization of Methotrexate – Pharmacy Services. 
  

07/05/2022

Added MA Bulletin numbered:

• 01-22-37 Medical Assistance Bulletin entitled - Prior Authorization of Thyroid Hormones - Pharmacy Services.
  
• 01-22-36 Medical Assistance Bulletin entitled - Prior Authorization of Smoking Cessation Products– Pharmacy Services.
  

07/01/2022

Added MA Bulletin numbered:

• 05-22-02 Medical Assistance Bulletin entitled - Reinstatement of Prior Authorization Requirements for Shift Care Services for Beneficiaries Under 21 Years of Age

06/30/2022

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Updated #85 - Department of Human Services (DHS) Breast & Cervical Cancer Prevention & Treatment (BCCPT) Program Updated July 2022
  

06/21/2022

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Revisions to Participating Drug Company list for Medicaid Drug Rebate Program

06/17/2022

Added Remittance Advice Dates - July  2022 Remittance Advice Dates

06/13/2022
Added MA Bulletin numbered:

• 08-22-13 Medical Assistance Bulletin entitled - Teledentistry Guidelines and Dental Fee Schedule Updates 
  

Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on June 22, 2022 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on June 23, 2022 at 10:00AM EDT - Register here.

 

06/10/2022

Added MA Bulletin numbered:

• 08-20-68 Medical Assistance Bulletin entitled - Federally Qualified Health Center and Rural Health Clinic Payment for SARS-CoV-2 Vaccine Administration
  
  

06/08/2022

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #261 - Important Changes are Coming for the Physical Health HealthChoices Program
  
  

06/06/2022
Added MA Bulletin numbered:

• 01-22-13 Medical Assistance Bulletin entitled - Updates to Blood Lead Reference Value and Environmental Lead Investigation (ELI) Provider Qualifications Requirements
  
  

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #260 - Provider Electronic Portal Update
  
  

06/03/2022
Added MA Bulletin numbered:

• 01-22-16 A Medical Assistance Bulletin entitled - Third Dose of Pediatric SARS-CoV-2 Vaccine Manufactured by Pfizer, Inc.
• 01-22-17 A Medical Assistance Bulletin entitled - Addition to Medical Assistance Program Fee Schedule for Administration of Ready-to-Use SARS-CoV-2 Vaccine Manufactured by Pfizer, Inc.

06/02/2022

Added Managed Care Delivery System Subcommittee agenda and draft file note - The June 2022 Managed Care Delivery System Subcommittee agenda and May 2022 draft file note have been posted and can be accessed from the Meeting Minutes archives page.

Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on June 9, 2022 at 10:00AM EDT - Register here.

05/19/2022

Added Remittance Advice Dates - June 2022 Remittance Advice Dates

05/12/2022
Added MA Bulletin numbered:

• 99-22-03 A Medical Assistance Bulletin entitled - 2022 Recommended Child and Adolescent Immunization Schedule
  

05/10/2022

Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on May 25, 2022 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on May 26, 2022 at 10:00AM EDT - Register here.

05/09/2022
Added MA Bulletin numbered:

• 01-22-11 A Medical Assistance Bulletin entitled - Addition of Monoclonal Antibody Product Bebtelovimab to the MA Program Fee Schedule

05/06/2022
Added MA Bulletin numbered:

• 99-22-02 A Medical Assistance Bulletin entitled - Updates to Guidelines for the Delivery of Physical Health Services via Telemedicine
  

Added Managed Care Delivery System Subcommittee agenda and draft file note - The May 2022 Managed Care Delivery System Subcommittee agenda and April 2022 draft file note have been posted and can be accessed from the Meeting Minutes archives page.

Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on May 12, 2022 at 10:00AM EDT - Register here.

05/02/2022
Added MA Bulletin numbered:

• 35-22-01 A Medical Assistance Bulletin entitled - School-Based ACCESS Program Provider Handbook Mid-Year Update
  

04/28/2022

Added the updated Pennsylvania Medicaid Managed Care Directory

04/26/2022

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Date of Death Recovery

04/21/2022

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• New Procedure Codes added to PA Medical Assistance Program Fee Schedule
  
  

Added Managed Care Enrollment Information:

• Added March  2022
  

04/19/2022

Added Remittance Advice Dates - May 2022 Remittance Advice Dates

04/18/2022
Added MA Bulletin numbered:

• 05-22-01 A Medical Assistance Bulletin entitled - Additions to the Medical Assistance Fee Schedule for Personal Care Services Provided to Beneficiaries Under the Age of 21.
  
  

04/15/2022

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #259 - Documentation for Shift Nursing (SN) and Home Health Aide (HHA) Prior Authorization and Program Exception Requests in the Fee-for-Service (FFS) Delivery System
  

04/11/2022

Added Managed Care Delivery System Subcommittee agenda and draft file note - The April 2022 Managed Care Delivery System Subcommittee agenda and March 2022 draft file note have been posted and can be accessed from the Meeting Minutes archives page.

Added Microsoft Teams Link to Join the Managed Care Delivery System Subcommittee Meeting - The Managed Care Delivery System Subcommittee meeting will be held on April 14, 2022 at 10:00AM EDT - Register here.

04/07/2022

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Provider Electronic Solutions Software or PES is Sunsetting

04/06/2022

Added Managed Care Enrollment Information:

• Added January 2022
  
• Added February 2022
  

03/31/2022

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Ordering, Referring and Prescribing Provider Enrollment Requirements

Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on April 27, 2022 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on April 28, 2022 at 10:00AM EDT - Register here.

Added MA Bulletin numbered: 

• 99-22-01 A Medical Assistance Bulletin entitled - Extension of Postpartum Coverage from 60 days to 12 Months

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #258 - Provider Electronic Solutions Software
  

03/30/2022

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #257 -  Medicare Sequestration Payment Reductions on All Claims Media Fee-for-Service (FFS) Claims Reinstated
  

03/25/2022
Added MA Bulletin numbered:

• 01-22-07 A Medical Assistance Bulletin entitled - Additions to the Medical Assistance Program Fee Schedule for Multiple Respiratory Pathogens Laboratory Tests
  

03/24/2022

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Revisions to Participating Drug Company list for Medicaid Drug Rebate Program

03/22/2022
Added MA Bulletin numbered:

• 01-22-09 A Medical Assistance Bulletin entitled - Prior Authorization of Anticonvulsants – Pharmacy Services
• 01-22-10 A Medical Assistance Bulletin entitled - Prior Authorization of Sedative Hypnotics – Pharmacy Services
  
  

03/21/2022
Added MA Bulletin numbered:

• 01-21-13 A Medical Assistance Bulletin entitled - MenQuadfi® and Vaxelis® Vaccines
  

03/17/2022

Added Remittance Advice Dates - April 2022 Remittance Advice Dates

03/11/2022

Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on March 23, 2022 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on March 24, 2022 at 10:00AM EDT - Register here.

03/07/2022
Added MA Bulletin numbered:

• 01-21-60 A Medical Assistance Bulletin entitled - Update to Age Limits for Payment for Administration of the Flucelvax® Quadrivalent Vaccine
  
  

03/04/2022

Updated Provider Quick Tips - The following Quick Tips have been added to the website.

• #121 -  Certification Renewal Required for Medical Assistance (MA) Providers Dispensing Hearing Aid Supplies (revised February 2022)

• #176 -  Presumptive Eligibility for Pregnant Women - 2022 Income Limits

03/02/2022
Added the updated Pennsylvania Medicaid Managed Care Directory

02/28/2022
Updated Healthy Beginnings Plus - Current Provider List

02/24/2022

Added MA Bulletin numbered:

• 01-21-59 A Medical Assistance Bulletin entitled - SARs-CoV-2 Monoclonal Antibody Product Updates
• 08-20-66 A Medical Assistance Bulletin entitled - Federally Qualified Health Center and Rural Health Clinic Payment for SARS-CoV-2 Vaccine Administration

02/18/2022

Added Remittance Advice Dates - March 2022 Remittance Advice Dates

02/14/2022
Added MA Bulletin numbered:

• 01-22-02 A Medical Assistance Bulletin entitled - Community-Based Care Management Services Provided by Centers of Excellence for Opioid Use Disorders (COEs)
  
  

Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on February 23, 2022 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on February 24, 2022 at 10:00AM EDT - Register here.

02/09/2022
Added MA Bulletin numbered:

• 01-22-08 A Medical Assistance Bulletin entitled - Preferred Specialty Pharmacy Drug Program Provider - Pharmacy Services

02/02/2022

Added Managed Care Enrollment Information:

• Added December 2021
  

02/01/2022

Added MA Bulletin numbered:

• 24-21-55 A Medical Assistance Bulletin entitled - At-Home Over-The-Counter COVID-19 Tests
  
  

Added Managed Care Enrollment Information:

• Added November 2021
  

 

01/28/2022

Added the updated Pennsylvania Medicaid Managed Care Directory

01/25/2022

Added MA Bulletin numbered:

• 01-22-06 A Medical Assistance Bulletin entitled - SARS-CoV-2 (COVID-19) Oral Antiviral Treatments with emergency use authorization (EUA) from the U.S. Food and Drug Administration (FDA)
  

01/24/2022

Added Managed Care Enrollment Information:

• Added October 2021
  

01/18/2022

Added Remittance Advice Dates - February 2022 Remittance Advice Dates

01/12/2022

Added MA Bulletin numbered:

• 01-22-03 A Medical Assistance Bulletin entitled - Prior Authorization of Aduhelm (aducanumab) - Pharmacy Services
  

01/11/2022

Added MA Bulletin numbered:

• 01-22-04 A Medical Assistance Bulletin entitled - Prior Authorization of Xyrem (sodium oxybate)/Xywav (calcium, magnesium, potassium, and sodium oxybates) - Pharmacy Services
  

01/07/2022

Added MA Bulletin numbered:

• 01-22-05 A Medical Assistance Bulletin entitled - Billing Procedure Update for Certified Registered Nurse Practitioners and Physicians Assistants
• Added Webinar Registration Links for Consumer Subcommittee Meeting - The Consumer Subcommittee meeting will be held on January 26, 2022 at 1:00PM EDT - Register here.
  
• Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on January 27, 2022 at 10:00AM EDT - Register here.

 

12/30/2021

Added MA Bulletin numbered:

• 01-21-19 A Medical Assistance Bulletin entitled - Vaccine Administration by Pharmacists - Pharmacy Services
  

12/28/2021

Added MA Bulletin numbered:

• 01-21-55 A Medical Assistance Bulletin entitled - Administration of a Booster Dose of the SARS-CoV-2 Vaccines
  
• 01-21-58 A Medical Assistance Bulletin entitled - Prior Authorization of HIV/AIDS Antiretrovirals - Pharmacy Services
  

12/27/2021

Added MA Bulletin numbered:

• 01-21-51 A Medical Assistance Bulletin entitled - Pediatric SARS-CoV-2 Vaccine Manufactured by Pfizer, Inc.
  
• 05-21-10 A Medical Assistance Bulletin entitled - Medical Assistance Program Fee Increases for Private Duty / Shift Nursing Services to MA Beneficiaries Under 21 Years of Age
  

12/21/2021

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Revisions to Participating Drug Company list for Medicaid Drug Rebate Program

12/17/2021

Added Remittance Advice Dates - January 2022 Remittance Advice Dates

12/16/2021

Added MA Bulletin numbered:

• 01-21-56 A Medical Assistance Bulletin entitled - Prior Authorization of Anticonvulsants - Pharmacy Services
  
• 01-21-57 A Medical Assistance Bulletin entitled - Prior Authorization of Sedative Hypnotics - Pharmacy Services
  

12/01/2021

Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on December 08, 2021 at 1:00PM EDT - Register here.

11/30/2021

Added MA Bulletin numbered:

• 27-21-02 A Medical Assistance Bulletin entitled - 2021 Medical Assistance Program Dental Fee Schedule Update
  

11/18/2021

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on December 9, 2021 at 10:00AM EDT - Register here.

Added Remittance Advice Dates - December 2021 Remittance Advice Dates

11/17/2021

Added MA Bulletin numbered:

• 01-21-52 A Medical Assistance Bulletin entitled - Prior Authorization of Growth Hormones - Pharmacy Services
  
• 01-21-53 A Medical Assistance Bulletin entitled - Prior Authorization of Immunosuppressives, Oral - Pharmacy Services
  
• 01-21-54 A Medical Assistance Bulletin entitled - Prior Authorization of Skeletal Muscle Relaxants - Pharmacy Services
  

11/16/2021

Added MA Bulletin numbered:

• 01-21-43 A Medical Assistance Bulletin entitled - Prior Authorization of VMAT2 Inhibitors - Pharmacy Services
  
• 01-21-44 A Medical Assistance Bulletin entitled - Prior Authorization of Zeposia (ozanimod) - Pharmacy Services
  

11/15/2021

Added MA Bulletin numbered:

• 01-21-38 A Medical Assistance Bulletin entitled - Prior Authorization of Pulmonary Hypertension Agents, Oral and Inhaled - Pharmacy Services
  
• 01-21-39 A Medical Assistance Bulletin entitled - Prior Authorization of Rilutek (riluzole) -Pharmacy Services-OBSOLETE
  
• 01-21-40 A Medical Assistance Bulletin entitled - Statewide Preferred Drug List (PDL) Implementation - Pharmacy Services
  
• 01-21-41 A Medical Assistance Bulletin entitled - Prior Authorization of Tysabri (natalizumab) - Pharmacy Services
• 01-21-42 A Medical Assistance Bulletin entitled - Prior Authorization of Ulcerative Colitis Agents - Pharmacy Services
  

 

Added MA Bulletin numbered:

• 01-21-31 A Medical Assistance Bulletin entitled - Prior Authorization of Lipotropics, Other - Pharmacy Services
  
• 01-21-32 A Medical Assistance Bulletin entitled - Prior Authorization of Monoclonal Antibodies (MABs) - Anti-IL Anti-IgE - Pharmacy Services
• 01-21-35 A Medical Assistance Bulletin entitled - Prior Authorization of Multiple Sclerosis Agents - Pharmacy Services
  
• 01-21-36 A Medical Assistance Bulletin entitled - Prior Authorization of Opioid Dependence Treatments - Pharmacy Services
• 01-21-37 A Medical Assistance Bulletin entitled - Prior Authorization of Pituitary Suppressive Agents, LHRH - Pharmacy Services
  

11/10/2021

Added MA Bulletin numbered:

• 01-21-30 A Medical Assistance Bulletin entitled - Prior Authorization of Immunomodulators, Atopic Dermatitis - Pharmacy Services
  
• 01-21-33 A Medical Assistance Bulletin entitled - Prior Authorization of Migraine Acute Treatment Agents - Pharmacy Services
• 01-21-34 A Medical Assistance Bulletin entitled - Prior Authorization of Migraine Prevention Agents - Pharmacy Services
  
• 01-21-47 A Medical Assistance Bulletin entitled - Prior Authorization of Glucocorticoids, Inhaled - Pharmacy Services
• 01-21-48 A Medical Assistance Bulletin entitled - Prior Authorization of Hepatitis C Agents - Pharmacy Services
  

Added the updated Pennsylvania Medicaid Managed Care Directory

11/08/2021

Added MA Bulletin numbered:

• 01-21-25 A Medical Assistance Bulletin entitled - Prior Authorization of Botulinum Toxins (Type A and Type B) - Pharmacy Services
• 01-21-27 A Medical Assistance Bulletin entitled - Prior Authorization of Chronic Obstructive Pulmonary Disease (COPD) Agents - Pharmacy Services
• 01-21-45 A Medical Assistance Bulletin entitled - Prior Authorization of Erythropoiesis Stimulating Agents (ESAs) - Pharmacy Services
  
• 01-21-46 A Medical Assistance Bulletin entitled - Prior Authorization of GI Motility, Chronic Agents - Pharmacy Services
• 01-21-49 A Medical Assistance Bulletin entitled - Prior Authorization of HIV/AIDS Antiretrovirals - Pharmacy Services
  
  

11/05/2021

Added MA Bulletin numbered:

• 01-21-23 A Medical Assistance Bulletin entitled - Prior Authorization of Bladder Relaxant Preparations - Pharmacy Services
• 01-21-24 A Medical Assistance Bulletin entitled - Prior Authorization of Bone Density Regulators - Pharmacy Services
• 01-21-26 A Medical Assistance Bulletin entitled - Prior Authorization of Bronchodilators, Beta Agonists - Pharmacy Services
• 01-21-28 A Medical Assistance Bulletin entitled - Prior Authorization of Cytokine and CAM Antagonists - Pharmacy Services
• 01-21-29 A Medical Assistance Bulletin entitled - Prior Authorization of Dupixent (dupilumab) - Pharmacy Services
  

11/04/2021

Added MA Bulletin numbered:

• 01-21-20 A Medical Assistance Bulletin entitled - Prior Authorization of Antiparasitics, Topical - Pharmacy Services
  
• 01-21-21  A Medical Assistance Bulletin entitled - Prior Authorization of Antipsychotics - Pharmacy Services
• 01-21-22 A Medical Assistance Bulletin entitled - Prior Authorization of Anxiolytics - Pharmacy Services
  

11/02/2021

Added MA Bulletin numbered:

• 01-21-14 A Medical Assistance Bulletin entitled - Prior Authorization of Alzheimer’s Agents - Pharmacy Services
  
• 01-21-15 A Medical Assistance Bulletin entitled - Prior Authorization of Antibiotics, GI and Related Agents - Pharmacy Services
  
• 01-21-16 A Medical Assistance Bulletin entitled - Prior Authorization of Antifungals, Topical - Pharmacy Services
• 01-21-17 A Medical Assistance Bulletin entitled - Prior Authorization of Antihemophilia Agents - Pharmacy Services
  
• 01-21-18 A Medical Assistance Bulletin entitled - Prior Authorization of Antihyperuricemics - Pharmacy Services
  

10/28/2021

Added Managed Care Enrollment Information:

• Added September 2021
  

10/22/2021

Added MA Bulletin numbered:

• 05-21-04 A Medical Assistance Bulletin entitled - Updated Error Status Code Descriptions for Personal Care Services Subject to Electronic Visit Verification
  

 

10/21/2021

Added MA Bulletin numbered:

• 08-21-07 A Medical Assistance Bulletin entitled - Naloxone Distribution by Federally Qualified Health Centers and Rural Health Clinics
  

10/19/2020

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #240 - Provider enrollment and revalidation changes during the COVID-19 emergency
  

10/18/2021

Added Remittance Advice Dates - November 2021 Remittance Advice Dates

10/15/2020

 Updated Provider Quick Tip - The following Quick Tip has been added to the website.

• Updated #207 - MA Program Fee Schedule Updates for Act 62 Procedure Codes
  
  

10/13/2021

Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on October 27, 2021 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on October 28, 2021 at 10:00AM EDT - Register here.

10/12/2021

Added Hospital Assessment Initiative  - The following Potentially Avoidable Admissions pages have been added to the website.

• Hospital Quality Incentive Program Webinar
  
• Hospital Quality Incentive Program (HQIP) Measurement - Potentially Avoidable Admission (PAA)
  

10/07/2021

Added PROMISeTM Provider Handbooks and Billing Guides Information:

• Updated 837 Professional / CMS-1500 Claim Form
  

• Updated CMS-1500 Billing Guide for PROMISeTM Healthy Beginnings Plus (HBP) Providers
  

10/04/2021

Added Managed Care Enrollment Information:

• Added August 2021
  

09/30/2021

Added MA Bulletin numbered

 

• 99-21-06 A Medical Assistance Bulletin entitled - Guidelines for the Delivery of Physical Health Services via Telemedicine
  

09/28/2021

Added Provider Quick Tips - The following Quick Tips have been added to the website.

• Added #256 - Procedure Code/Modifier Combinations to be Utilized when Requesting Home Accessibility Durable Medical Equipment (DME) in the Fee-for-Service Delivery System
  

09/24/2021

Added MA Bulletin numbered:

• 01-21-06 A Medical Assistance Bulletin entitled - Updates to the Family Planning Services Program Fee Schedule

09/23/2021

Added the updated Pennsylvania Medicaid Managed Care Directory

09/22/2021

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Revisions to Participating Drug Company list for Medicaid Drug Rebate Program

 

09/21/2021

Added MA Bulletin numbered:

• 09-21-04 A Medical Assistance Bulletin entitled - Coverage of Home Accessibility Durable Medical Equipment and Procedure for obtaining an 1150 Administrative Waiver in the Fee-for-Service Delivery System

 

Added Provider Quick Tips - The following Quick Tips have been added to the website.

• Added #255 - Provider Revalidation Requirements

09/20/2021

Added Remittance Advice Dates - October 2021 Remittance Advice Dates

09/17/2021

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Provider Revalidation Reinstated June 1, 2021
  

09/10/2021

Added Managed Care Enrollment Information:

• Added July 2021
  

09/08/2021

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Community Support Service Providers - Federal Financial Participation Rate Change and Continued Billing Requirements
  
  

Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on September 22, 2021 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on September 23, 2021 at 10:00AM EDT - Register here.

09/03/2021

Added MA Bulletin numbered:

• 01-21-12 A Medical Assistance Bulletin entitled — Administration of a Third Dose of SARS-CoV-2 Vaccines Manufactured by Pfizer, Inc. and Moderna, Inc
  

08/20/2021

Added Remittance Advice Dates - September 2021 Remittance Advice Dates

Added MA Bulletin numbered:

• 99-21-04 A Medical Assistance Bulletin entitled 2021 Healthcare Common Procedure Coding System (HCPCS) Updates, Fee Adjustments and Other Procedure Code Changes. 

07/30/2021

Added MA Bulletin numbered:

• 01-21-11 A Medical Assistance Bulletin entitled Corrected - Expansion of Providers for the Administration of SARS-CoV-2 Vaccines and Monoclonal Antibody Therapy

07/29/2021

Added MA Bulletin numbered:

• 01-21-04 A Medical Assistance Bulletin entitled SARS-CoV-2 Vaccine Administration for Beneficiaries who are Homebound
• 01-21-08 A Medical Assistance Bulletin entitled Expansion of Providers for the Administration of SARS-CoV-2 Vaccines and Monoclonal Antibody Therapy - OBSOLETE

07/27/2021

 

Added the updated Pennsylvania Medicaid Managed Care Directory

07/22/2021

Added Managed Care Enrollment Information:

• Added April 2021,  May 2021 and June 2021

07/16/2021

Added Remittance Advice Dates - August 2021 Remittance Advice Dates

07/08/2021

Added MA Bulletin numbered:

• OMHSAS-21-06 A Medical Assistance Bulletin entitled Opioid Treatment Program Services for Dually Eligible Individuals

07/06/2021

Added MA Bulletin numbered:

• 24-21-05 A Medical Assistance Bulletin entitled Medical Assistance Program Fee Increase for Disposable Gloves

07/02/2021

Updated Provider Enrollment Documents: 

• 11 - Mental Health/Substance Abuse Services Providers Mental Health/Substance Abuse Provider Requirements
• 21 - Case ManagerCase ManagerRequirements

06/30/2021

Added MA Bulletin numbered:

• 99-20-09 A Medical Assistance Bulletin entitled Medical Assistance (MA) Program Fee Schedule Revisions

06/29/2021

Added Provider Quick Tips - The following Quick Tips have been added to the website.

• Added #254 -  Payment Error Rate Measurement (PERM) Initiative for RY 2022

06/28/2021

Added MA Bulletin numbered:

• 99-21-05 A Medical Assistance Bulletin entitled 2021 Recommended Child and Adolescent Immunization Schedule

06/25/2021

Updated Provider Enrollment Documents: 

• 11 - Mental Health/Substance Abuse Services Providers Mental Health/Substance Abuse Provider Requirements
• 21 - Case ManagerCase ManagerRequirements

06/24/2021

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Revisions to Participating Drug Company list for Medicaid Drug Rebate Program

Added MA Bulletin numbered:

• 99-21-02 A Medical Assistance Bulletin entitled Pennsylvania's Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule

06/23/2021

Updated Provider Quick Tips - The following Quick Tips have been updated to the website.

• Updated #232 Billing Guidance for Alternative Screening Sites Related to COVID-19
• Updated #233 Waiver of Prudent Pay During COVID-19 Emergency
• Updated #237 Teledentistry Guidelines Related to COVID-19 for Dentists, Federally Qualified Health Centers and Rural Health Clinics
• Updated #242 Telemedicine Guidelines Related to COVID-19
• Updated #244 MA Eligibility During COVID-19 Emergency Disaster Declaration
• Updated #247 Nonemergency Ambulance Transportation Related to COVID-19

06/22/2021
Updated Healthy Beginnings Plus - Current Provider List

06/14/2021

Added Remittance Advice Dates - July 2021 Remittance Advice Dates

06/04/2021
Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on June 23, 2021 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on June 24, 2021 at 10:00AM EDT - Register here.

05/20/2021

Updated Provider Enrollment Documents: 

• 08 - Clinic FQHC Requirements / Additional Information
• 08 - Clinic RHC Requirements / Additional Information
• 09 - Certified Registered Nurse Practitioner (CRNP)CRNPRequirements
• 11 - Mental Health/Substance Abuse Services Providers Mental Health/Substance Abuse Provider Requirements
• 17 - TherapistTherapistRequirements
• 19 - PsychologistPsychologist Requirements
• 21 - Case ManagerCase ManagerRequirements
• 31 - Physician/Physician GroupPhysician Requirements

05/18/2021

Added MA Bulletin numbered:

• 01-20-10 A Medical Assistance Bulletin entitled Addition of COVID-19 Antigen Laboratory Test Codes to the MA Program Fee Schedule

 Added Remittance Advice Dates - June 2021 Remittance Advice Dates

 

Added the updated Pennsylvania Medicaid Managed Care Directory

 

04/30/2021

Added MA Bulletin numbered:

• 99-21-03 A Medical Assistance Bulletin entitled Reinstatement of Prior Authorization Requirements for Certain Services

04/27/2021

Added Provider Quick Tips - The following Quick Tips have been added to the website.

• Updated #41 - Medical Assistance Desk Reference (updated April 2021)

04/19/2021

Added MA Bulletin numbered:

• 01-21-03 A Medical Assistance Bulletin entitled Fee Increase for the Administration of SARS-CoV-2 Vaccines

04/16/2021

Added Remittance Advice Dates - May 2021 Remittance Advice Dates

04/15/2021

Added MA Bulletin numbered:

• 08-21-01 A Medical Assistance Bulletin entitled Dental Benefit Limit Exception Process Update

04/14/2021

 

Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on April 21, 2021 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on April 22, 2021 at 10:00AM EDT - Register here.

03/25/2021

Added MA Bulletin numbered:

• 01-20-61 A Medical Assistance Bulletin  Addition to Medical Assistance Program Fee Schedule for Administration of SARS-CoV-2 Monoclonal Antibody Therapy

03/23/2021

Added MA Bulletin numbered:

• 99-21-01 A Medical Assistance Bulletin Restoration of Provider Revalidation Requirements

 

03/22/2021

Added MA Bulletin numbered:

• 01-21-02 A Medical Assistance Bulletin Updates to the Medical Assistance Program Fee Schedule for Administration of SAR-CoV-2 Monoclonal Antibody Therapy

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

•  Revisions to Participating Drug Company list for Medicaid Drug Rebate Program

 

03/18/2021

 

Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on March 24, 2021 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on March 25, 2021 at 10:00AM EDT - Register here.

 

Added Managed Care Enrollment Information:

• Added February 2021

03/15/2021

Added Remittance Advice Dates - April 2021 Remittance Advice Dates

03/11/2021

Added MA Bulletin numbered:

• 01-21-01 A Medical Assistance Bulletin entitled  Administration of SARS-CoV-2 Vaccine Manufactured by Janssen Biotech, Inc.

 

Added the updated Pennsylvania Medicaid Managed Care Directory

02/22/2021

 

Added Managed Care Enrollment Information:

• Added January 2021
  

02/17/2021

Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on February 24, 2021 at 1:00PM EDT - Register here.

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on February 25, 2021 at 10:00AM EDT - Register here.

Added Provider Quick Tips - The following Quick Tips have been added to the website.

• 85 - Department of Human Services (DHS) Breast and Cervical Cancer Prevention and Treatment (BCCPT) Program (updated February 2021)
• 176 - Presumptive Eligibility for Pregnant Women - 2021 Income Limits
  

02/16/2021

Added Remittance Advice Dates - March 2021 Remittance Advice Dates

01/28/2021

Added Provider Quick Tips - The following Quick Tips have been added to the website.

• Added #253 - Year 2020 Pennsylvania Medicaid 1099s issued by PROMISeTM

01/26/2021

Added MA Bulletin numbered:

• 01-20-62 A Medical Assistance Bulletin entitled SARS-CoV-2 Vaccine Updates

Added Managed Care Enrollment Information:

• Added December 2020
  

01/25/2021

Added Provider Quick Tips - The following Quick Tips have been added to the website.

• Added #252 - Medical Assistance Benefits for Beneficiaries Turning 21 During the COVID-19 Emergency
  

01/21/2021

Added Provider Quick Tips - The following Quick Tips have been added to the website.

• Updated #121 -  Certification Renewal Required for Medical Assistance (MA) Providers Dispensing Hearing Aid Supplies (revised January 2021)

01/20/2021

Added Remittance Advice Dates - February 2021 Remittance Advice Dates

12/30/2020

Added MA Bulletin numbered:

• 01-20-60 A Medical Assistance Bulletin entitled SARS-CoV-2 Vaccine Administration by Pharmacists

12/24/2020

Added MA Bulletin numbered:

• 01-20-59 A Medical Assistance Bulletin entitled Addition to the Medical Assistance Program Fee Schedule for Administration of SARS-CoV-2 Vaccines

12/16/2020

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

•  Revisions to Participating Drug Company list for Medicaid Drug Rebate Program

12/15/2020

Added MA Bulletin numbered:

• 01-20-50 A Medical Assistance Bulletin entitled Prior Authorization of Crysvita (burosumab) - Pharmacy Services 
• 01-20-51 A Medical Assistance Bulletin entitled Prior Authorization of Complement Inhibitors - Pharmacy Services 
• 01-20-52 A Medical Assistance Bulletin entitled Prior Authorization of Corlanor (ivabradine) - Pharmacy Services 
• 01-20-53 A Medical Assistance Bulletin entitled Prior Authorization of Spinraza (nusinersen) - Pharmacy Services 
• 01-20-54 A Medical Assistance Bulletin entitled Prior Authorization of Tepezza (teprotumumab) - Pharmacy Services

12/14/2020

Added MA Bulletin numbered:

• 01-20-49 A Medical Assistance Bulletin entitled Prior Authorization of Cystic Fibrosis Transmembrane Regulator (CFTR) Modulators - Pharmacy Services
• 01-20-55 A Medical Assistance Bulletin entitled Prior Authorization of Duchenne Muscular Dystrophy (DMD) Antisense Oligonucleotides - Pharmacy Services 
• 01-20-56 A Medical Assistance Bulletin entitled Prior Authorization of Evrysdi (risdiplam) - Pharmacy Services
• 01-20-57 A Medical Assistance Bulletin entitled Prior Authorization of Palforzia [peanut (Arachis hypogaea) allergen powder] - Pharmacy Services 
• 01-20-58 A Medical Assistance Bulletin entitled Prior Authorization of Xyrem (sodium oxybate)/Xywav (calcium, magnesium, potassium, and sodium oxybates) - Pharmacy Services

Added Remittance Advice Dates - January 2021 Remittance Advice Dates

12/02/2020

Added MA Bulletin numbered:

• 27-20-01 A Medical Assistance Bulletin entitled Medical Assistance Program Dental Fee Schedule Update

11/24/2020

Added MA Bulletin numbered:

• 01-20-47 A Medical Assistance Bulletin entitled Prior Authorization of Cytokine and CAM antagonists - Pharmacy Services
• 01-20-48 A Medical Assistance Bulletin entitled Prior Authorization of Tysabri (natalizumab) - Pharmacy Services

Added Managed Care Enrollment Information:

• Added October 2020

11/16/2020

Added MA Bulletin numbered:

• 01-20-42 A Medical Assistance Bulletin entitled Prior Authorization of Sickle Cell Agents - Pharmacy Services
• 01-20-43 A Medical Assistance Bulletin entitled Statewide Preferred Drug List (PDL) Implementation - Pharmacy Services
• 01-20-44 A Medical Assistance Bulletin entitled Prior Authorization of Stimulants and Related Agents - Pharmacy Services
• 01-20-45 A Medical Assistance Bulletin entitled Prior Authorization of Synagis (palivizumab) - Pharmacy Services

11/13/2020

Added Remittance Advice Dates - December 2020 Remittance Advice Dates

Added MA Bulletin numbered:

• 01-20-38 A Medical Assistance Bulletin entitled Prior Authorization of Opioid Dependence Treatments - Pharmacy Services
• 01-20-39 A Medical Assistance Bulletin entitled Prior Authorization of Pituitary Suppressive Agents, LHRH - Pharmacy Services
• 01-20-40 A Medical Assistance Bulletin entitled Prior Authorization of Progestational Agents - Pharmacy Services
• 01-20-41 A Medical Assistance Bulletin entitled Prior Authorization of Sedative Hypnotics - Pharmacy Services

11/12/2020

Added MA Bulletin numbered:

• 99-20-03 A Medical Assistance Bulletin entitled 2020 Recommended Child and Adolescent Immunization Schedule
• 01-20-33 A Medical Assistance Bulletin entitled Prior Authorization of Lipotropics, Other - Pharmacy Services
• 01-20-34 A Medical Assistance Bulletin entitled Prior Authorization of Migraine Acute Treatment Agents (formerly Antimigraine Agents, Triptans) - Pharmacy Services
• 01-20-35 A Medical Assistance Bulletin entitled Prior Authorization of Migraine Prevention Agents (formerly Antimigraine Agents, Other) - Pharmacy Services
• 01-20-36 A Medical Assistance Bulletin entitled Prior Authorization of Multiple Sclerosis Agents- Pharmacy Services
• 01-20-37 A Medical Assistance Bulletin entitled Prior Authorization of NSAIDs - Pharmacy Services

11/10/2020

Added MA Bulletin numbered:

• 01-20-26 A Medical Assistance Bulletin entitled Prior Authorization of HIV/AIDS Antiretrovirals - Pharmacy Services
• 01-20-27 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemia Treatments - Pharmacy Services
• 01-20-28 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, SGLT2 Inhibitors - Pharmacy Services
• 01-20-29 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, Incretin Mimetics/Enhancers - Pharmacy Services
• 01-20-30 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, TZDs - Pharmacy Services
• 01-20-31 A Medical Assistance Bulletin entitled Prior Authorization of Idiopathic Pulmonary Fibrosis (IPF) Agents - Pharmacy Services
• 01-20-32 A Medical Assistance Bulletin entitled Prior Authorization of Intra-Articular Hyaluronates - Pharmacy Services

11/09/2020

Added MA Bulletin numbered:

• 01-20-17 A Medical Assistance Bulletin entitled Prior Authorization of Androgenic Agents - Pharmacy Services
• 01-20-18 A Medical Assistance Bulletin entitled Prior Authorization of Anticonvulsants - Pharmacy Services
• 01-20-19 A Medical Assistance Bulletin entitled Prior Authorization of antidepressants, Other - Pharmacy Services
• 01-20-20 A Medical Assistance Bulletin entitled Prior Authorization of Anxiolytics - Pharmacy Services
• 01-20-23 A Medical Assistance Bulletin entitled Prior Authorization of Hematopoietic Mixtures (Formerly Iron, Oral) - Pharmacy Services
• 01-20-24 A Medical Assistance Bulletin entitled Prior Authorization of Hepatitis C Agents - Pharmacy Services
• 01-20-25 A Medical Assistance Bulletin entitled Prior Authorization of Hereditary Angioedema (HAE) Agents - Pharmacy Services

11/06/2020

Added MA Bulletin numbered:

• 01-20-11 A Medical Assistance Bulletin entitled Prior Authorization of Analgesics, Non-Opioid Barbiturate Combinations - Pharmacy Services
• 01-20-12 A Medical Assistance Bulletin entitled Prior Authorization of Analgesics, Opioid Long-Acting - Pharmacy Services
• 01-20-13 A Medical Assistance Bulletin entitled Prior Authorization of Analgesics, Opioid Short-Acting - Pharmacy Services
• 01-20-14 A Medical Assistance Bulletin entitled Prior Authorization of Bone Density Regulators - Pharmacy Services
• 01-20-15 A Medical Assistance Bulletin entitled Prior Authorization of COPD Agents - Pharmacy Services
• 01-20-16 A Medical Assistance Bulletin entitled Prior Authorization of Estrogens - Pharmacy Services
• 01-20-22 A Medical Assistance Bulletin entitled Prior Authorization of H. Pylori Treatments - Pharmacy Services

10/19/2020

Added Managed Care Enrollment Information.

• Added September 2020

10/15/2020

Added Remittance Advice Dates - November 2020 Remittance Advice Dates

10/01/2020

Added MA Bulletin numbered:

• 24-20-02 A Medical Assistance Bulletin entitled COVID-19 Specimen Collection and Testing at Pharmacies

09/22/2020

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Revisions to Participating Drug Company list for Medicaid Drug Rebate Program

Added MA Bulletin numbered:

• 35-20-01 A Medical Assistance Bulletin entitled School-Based ACCESS Prgram Provider Handbook

09/17/2020

 

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on September 24, 2020 10:00AM EDT - Register here.

Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on September 23, 2020 1:00PM EDT - Register here.

Added Managed Care Enrollment Information.

• Added August  2020

09/15/2020

Added MA Bulletin numbered:

• 08-20-03 A Medical Assistance Bulletin entitled Behavioral Health Group Therapy Provided in Federally Qualified Health Center and Rural Health Clinic Settings
• 08-20-04 A Medical Assistance Bulletin entitled Vision Services Provided in Federally Qualified Health Center and Rural Health Clinic Settings

09/11/2020

Added Remittance Advice Dates - October 2020 Remittance Advice Dates

09/10/2020

Added MA Bulletin numbered:

• 07-20-04 A Medical Assistance Bulletin entitled Electronic Visit Verification (EVV) for Personal Care Services (PCS)

09/08/2020

Added MA Bulletin numbered:

• 01-20-09 A Medical Assistance Bulletin entitled Specialty Pharmacy Drug Program Preferred Specialty Pharmacy Providers - Pharmacy Services

09/01/2020

Added Managed Care Enrollment Information.

• Added July 2020

08/26/2020

Added MA Bulletin numbered:

• 05-20-03 A Medical Assistance Bulletin entitled Electronic Visit Verification for Personal Care Services Provided in the Fee-for-Service Delivery System

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Community Support Service Providers - Federal Financial Participation Rate Change and Continued Billing Requirements

08/14/2020

Added Remittance Advice Dates - September 2020 Remittance Advice Dates

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Updated #250 -  Version 37.1 of All Patient Refined-Diagnosis Related Group (APR DRG) Implementation

08/12/2020

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Behavioral Health MCO corrections to credits setup erroneously on the cycle 06 RA dated August 10, 2020

07/29/2020

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #251 - Medical Assistance Benefits for Beneficiaries Turning 21 During the COVID-19 Emergency

07/24/2020

Added Managed Care Enrollment Information.

• Added April, May & June 2020

07/17/2020

Added Remittance Advice Dates - August 2020 Remittance Advice Dates

Added Medical Assistance Advisory Committee Meeting minutes, agenda, and attachments - The June 2020 MAAC Webinar Audience Questions have been posted and can be accessed from the Meeting Minutes archives page.

07/08/2020

Added Webinar Registration Links for Medical Assistance Advisory Committee Meeting - The MAAC meeting will be held on July 23, 2020 10:00AM EDT - Register here.

Added Webinar Registration Links for Consumer Subcommittee Meeting agenda and attachment - The Consumer Subcommittee meeting will be held on July 22, 2020 1:00PM EDT - Register here.

07/02/2020

Added MA Bulletin numbered:

• 01-20-08  A Medical Assistance Bulletin entitled Addition of Opioid Use Disorder Centers of Excellence Provider Specialty

06/26/2020

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Revisions to Participating Drug Company List for Medicaid Drug Rebate Program

06/24/2020

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #249 -  New MA ACCESS Card

Added MA Bulletin numbered:

• 99-20-08 A Medical Assistance Bulletin entitled Update to the Medical Assistance ACCESS ID Card

06/18/2020

Added MA Bulletin numbered:

• 01-20-04  A Medical Assistance Bulletin entitled Updates to the Procedures for Presumptive Eligibility as Determined by Hospitals

06/16/2020

Provider's ordering MA Provider Forms Electronically

06/12/2020

Added MA Bulletin numbered:

• 99-20-07  A Medical Assistance Bulletin entitled “Payment in Full” and Personal Protective Equipment

06/11/2020

Added MA Bulletin numbered

 

• 05-20-02 A Medical Assistance Bulletin entitled Implementation of Electronic Visit Verification in the FFS and Physical Health Managed Care Delivery Systems

05/27/2020

Added MA Bulletin numbered:

• 01-20-07  A Medical Assistance Bulletin entitled Pharmacy Services for Medical Assistance Beneficiaries Related to the COVID-19 Public Health Emergency
  

 

05/26/2020

 Updated Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #207 - MA Program Fee Schedule Updates for Act 62 Procedure Codes

Added MA Bulletin numbered:

• 99-20-02 A Medical Assistance Bulletin entitled 2020 Healthcare Common Procedure Coding System (HCPCS) Updates
• 99-20-04 A Medical Assistance Bulletin entitled Pennsylvania's Early and Periodic Screening Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
• 01-20-06 A Medical Assistance Bulletin entitled Updates to Childhood Nutrition and Weight Management Services

05/20/2020

Added MA Bulletin numbered:

• 99-20-06 A Medical Assistance Bulletin entitled ICD-10-CM Official Coding Guidelines Related to COVID-19

05/19/2020

 Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #248 - DexCom Continuous Glucose Monitoring Products Coverage

05/08/2020

 Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #247 - Nonemergency Ambulance Transportation Related to COVID-19

05/07/2020

 Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #246 - Rescinding Prior Guidance on Elective Services

05/01/2020

Added MA Bulletin numbered:

• 09-20-05 A Medical Assistance Bulletin entitled Home Health Services, Medical Supplies, Equipment and Appliances Prescribed by Non-physician Practitioners
• 99-20-05  A Medical Assistance Bulletin entitled COVID-19 Testing and Related Treatment Exempt from MA Copayment Requirements
• 09-20-06  A Medical Assistance Bulletin entitled Addition of the Multi-Function Ventilator to the Medical Assistance Program Fee Schedule
• 01-20-05  A Medical Assistance Bulletin entitled Addition of Coronavirus Laboratory Test Codes to the MA Program Fee Schedule

04/30/2020

 Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #245 - All Patient Refined-Diagnosis Related Group (APR-DRG) to be Updated with COVID-19 Billing Codes  

04/17/2020

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #244 -  MA Eligibility During COVID-19 Emergency Disaster Declaration 

04/16/2020

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #243 - Use of the CR Modifier and DR Condition Code for COVID-19 Disaster/Emergency Related Claims

04/09/2020

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #242 - Telemedicine Guidelines Related to COVID-19
• Added #241 - Prior Authorization Changes in the Medical Assistance Program for Certain Services during COVID0-19 Emergency Disaster
• Added #240 - Provider enrollment and revalidation changes during the COVID-19 emergency

04/07/2020

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #239 - Short-acting beta agonist metered dose inhalers temporarily added to Statewide Preferred Drug List 
• Added #238 - 90-Day Supplies of Medications - COVID-19
• Added #237 - Teledentistry Guidelines Related to COVID-19 for Dentists, Federally Qualified Health Centers and Rural Health

04/03/2020

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Added #236 - Hydroxychloroquine Quantity Limits

 

12/31/2019

Added MA Bulletin numbered:

• 99-19-07 A Medical Assistance Bulletin entitled Place of Service Review and Updates to Surgical Services

12/10/2019

Added MA Bulletin numbered:

• 01-19-14 A Medical Assistance Bulletin entitled Billing for Inpatient Hospital and Short Procedure Unit Services When a MA Beneficiary is Directly Admitted from Observation

12/06/2019

Added MA Bulletin numbered:

• 01-19-100 A Medical Assistance Bulletin entitled Prior Authorization of Anti-Allergens, Oral-Pharmacy Services
• 01-19-106 A Medical Assistance Bulletin entitled Prior Authorization of Antimigraine Agents, Other-Pharmacy Services
• 01-19-116 A Medical Assistance Bulletin entitled Prior Authorization of Macular Degeneration Agents - Pharmacy Services
• 01-19-113 A Medical Assistance Bulletin entitled Prior Authorization of Pulmonary Arterial Hypertension (PAH) Agents, Oral and Inhaled - Pharmacy Services
• 01-19-101 A Medical Assistance Bulletin entitled Prior Authorization of Analgesics, Opioid Short-Acting - Pharmacy Services
• 01-19-109 A Medical Assistance Bulletin entitled Prior Authorization of Growth Hormones - Pharmacy Services
• 01-19-99 A Medical Assistance Bulletin entitled Prior Authorization of Antibiotics, GI and Related Agents - Pharmacy Services

Added MA Bulletin numbered:

• 01-19-29 A Medical Assistance Bulletin entitled Prior Authorization of Vitamin D Analogs – Pharmacy Services
• 01-19-41 A Medical Assistance Bulletin entitled Prior Authorization of Thrombopoietics – Pharmacy Services
• 01-19-31 A Medical Assistance Bulletin entitled Prior Authorization of Urinary Anti-Infectives – Pharmacy Services
• 99-19-06 A Medical Assistance Bulletin entitled Corrected - Diabetes Prevention Program Enrollment in the Medical Assistance Program
• 01-19-13 A Medical Assistance Bulletin entitled Family Planning Services Program
• 01-19-51 A Medical Assistance Bulletin entitled Prior Authorization of Antihistamines, Minimally Sedating – Pharmacy Services
• 01-19-50 A Medical Assistance Bulletin entitled Prior Authorization of Antihyperuricemics – Pharmacy Services
• 01-19-52 A Medical Assistance Bulletin entitled Prior Authorization of Antihemophilia Agents – Pharmacy Services
• 01-19-62 A Medical Assistance Bulletin entitled Prior Authorization of Intranasal Rhinitis Agents – Pharmacy Services
• 01-19-49 A Medical Assistance Bulletin entitledPrior Authorization of Bronchodilators, Beta Agonists – Pharmacy Services
• 01-19-53 A Medical Assistance Bulletin entitled Prior Authorization of Anticoagulants – Pharmacy Services
• 01-19-58 A Medical Assistance Bulletin entitled Prior Authorization of GI Motility, Chronic Agents – Pharmacy Services
• 01-19-54 A Medical Assistance Bulletin entitled Prior Authorization of Estrogens – Pharmacy Services
• 01-19-59 A Medical Assistance Bulletin entitled Prior Authorization of Oncology Agents, Breast Cancer – Pharmacy Services
• 01-19-61 A Medical Assistance Bulletin entitled Prior Authorization of Iron Chelating Agents – Pharmacy Services
• 01-19-60 A Medical Assistance Bulletin entitled Prior Authorization of Multiple Sclerosis Agents – Pharmacy Services
• 01-19-55 A Medical Assistance Bulletin entitled Prior Authorization of Sedative Hypnotics – Pharmacy Services
• 01-19-57 A Medical Assistance Bulletin entitled Prior Authorization of Urea Cycle Disorder Agents – Pharmacy Services
• 01-19-48 A Medical Assistance Bulletin entitledPrior Authorization of Ulcerative Colitis Agents – Pharmacy Services
• 01-19-56 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Anti-Inflammatories – Pharmacy Services
• 01-19-64 A Medical Assistance Bulletin entitled Prior Authorization of Stimulants and Related Agents – Pharmacy Services
• 01-19-47 A Medical Assistance Bulletin entitled Prior Authorization of Potassium Removing Agents – Pharmacy Services
• 01-19-63 A Medical Assistance Bulletin entitled Prior Authorization of Hypoglycemics, Meglitinides – Pharmacy Services
• 35-19-01 A Medical Assistance Bulletin entitled School-Based ACCESS Program Provider Handbook
• 01-19-21 A Medical Assistance Bulletin entitled Updates to Sterilization Consent Form (MA 31)
• 01-19-65 A Medical Assistance Bulletin entitled Statewide Preferred Drug List (PDL) Implementation – Pharmacy Services
• 01-19-79 A Medical Assistance Bulletin entitled Prior Authorization of Glucocorticoids, Inhaled – Pharmacy Services
• 01-19-94 A Medical Assistance Bulletin entitledPrior Authorization of Antimigraine Agents, Triptans – Pharmacy Services
• 01-19-84 A Medical Assistance Bulletin entitled Prior Authorization of Blood Glucose Meters and Test Strips (Formerly Diabetic Meters and Diabetic Strips) – Pharmacy Services
• 01-19-86 A Medical Assistance Bulletin entitled Prior Authorization of Anticonvulsants – Pharmacy Services
• 01-19-83 A Medical Assistance Bulletin entitled Prior Authorization of Fluoroquinolones, Oral – Pharmacy Services
• 01-19-97 A Medical Assistance Bulletin entitledPrior Authorization of BPH Treatments – Pharmacy Services
• 01-19-82 A Medical Assistance Bulletin entitled Prior Authorization of Antifungals, Oral – Pharmacy Services
• 01-19-85 A Medical Assistance Bulletin entitled Prior Authorization of Antidepressants, SSRIs – Pharmacy Services
• 01-19-87 A Medical Assistance Bulletin entitled Prior Authorization of Acne Agents, Topical – Pharmacy Services
• 01-19-88 A Medical Assistance Bulletin entitled Prior Authorization of Antiemetic/Antivertigo Agents – Pharmacy Services
• 01-19-96 A Medical Assistance Bulletin entitled Prior Authorization of Histamine 2 (H2) Receptor Blockers – Pharmacy Services
• 01-19-78 A Medical Assistance Bulletin entitled Prior Authorization of Growth Factors – Pharmacy Services
• 01-19-76 A Medical Assistance Bulletin entitled Prior Authorization of Immunosuppressives, Oral – Pharmacy Services
• 01-19-81 A Medical Assistance Bulletin entitled Prior Authorization of Intra-Articular Hyaluronates – Pharmacy Services
• 01-19-77 A Medical Assistance Bulletin entitled Prior Authorization of Idiopathic Pulmonary Fibrosis (IPF) Agents – Pharmacy Services
• 01-19-72 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Allergic Conjunctivitis (Formerly Ophthalmic Agents for Allergic Conjunctivitis) – Pharmacy Services
• 01-19-68 A Medical Assistance Bulletin entitledPrior Authorization of Ophthalmics, Immunomodulators (Formerly Ophthalmic Immunomodulators) – Pharmacy Services
• 01-19-74 A Medical Assistance Bulletin entitled Prior Authorization of Macrolides (Formerly Macrolides/Ketolides) – Pharmacy Services
• 01-19-75 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Glaucoma (Formerly Ophthalmic Agents for Glaucoma) – Pharmacy Services
• 01-19-67 A Medical Assistance Bulletin entitledPrior Authorization of Opioid Overdose Agents (Formerly Opiate Overdose Agents) – Pharmacy Services
• 01-19-71 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Antibiotics (Formerly Ophthalmic Antibiotics) – Pharmacy Services
• 01-19-95 A Medical Assistance Bulletin entitled Prior Authorization of Iron, Oral - Pharmacy Services
• 01-19-80 A Medical Assistance Bulletin entitled Prior Authorization of Iron, Parenteral – Pharmacy Services
• 01-19-70 A Medical Assistance Bulletin entitled Prior Authorization of Ophthalmics, Antibiotic-Steroid Combinations (Formerly Ophthalmic Antibiotic-Steroid Combinations) – Pharmacy Services
• 01-19-73 A Medical Assistance Bulletin entitled Prior Authorization of Neuropathic Pain Agents – Pharmacy Services
• 01-19-66 A Medical Assistance Bulletin entitled Prior Authorization of Otic Antibiotics (Formerly Otic Antibiotic Preparations) – Pharmacy Services
• 01-19-93 A Medical Assistance Bulletin entitled Prior Authorization of Proton Pump Inhibitors (PPIs) - Pharmacy Services
• 01-19-92 A Medical Assistance Bulletin entitled  Prior Authorization of Prenatal Vitamins – Pharmacy Services
• 27-19-17 A Medical Assistance Bulletin entitled  Medical Assistance Program Dental Fee Schedule and Dental Provider Handbook Update
• 01-19-90 A Medical Assistance Bulletin entitled Prior Authorization of Steroids, Topical (Formerly Steroids, Topical Low; Steroids, Topical Medium;Steroids, Topical High; and Steroids, Topical Very High) – Pharmacy Services
• 01-19-91 A Medical Assistance Bulletin entitled Prior Authorization of Tetracyclines – Pharmacy Services
• 01-19-89 A Medical Assistance Bulletin entitled Prior Authorization of Skeletal Muscle Relaxants – Pharmacy Services
• 01-19-69 A Medical Assistance Bulletin entitled Prior Authorization of Pancreatic Enzymes – Pharmacy Services
• OMHSAS-19-03 A Medical Assistance Bulletin entitled Guidelines for Implementing Assisted Outpatient Treatment

 Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

•  Revisions to Participating Drug Company list for Medicaid Drug Rebate Program
• Community Support Service Providers - Federal Financial Participation Rate Change and Continued Billing Requirements

Added Remittance Advice Dates

• September 2019 Remittance Advice Dates
• October 2019 Remittance Advice Dates
• November 2019 Remittance Advice Dates
  

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• Updated #11 - The Eligibility Verification System (EVS) 

Added Managed Care Delivery System Subcommittee agenda, draft file note and attachment - The September 2019 Managed Care Delivery System Subcommittee agenda and July  2019 draft file note and attachment have been posted and can be accessed from the Meeting Minutes archives page

Added Managed Care Delivery System Subcommittee agenda, draft file note and attachment - The October 2019 Managed Care Delivery System Subcommittee agenda and September 2019 draft file note and attachment have been posted and can be accessed from the Meeting Minutes archives page

Added the Fee-for-Service Subcommittee Meeting minutes - The August 2019 Fee-for-Service Subcommittee minutes have been posted and can be accessed from the Meeting Minutes archives page.

11/09/2019

Added MA Bulletin numbered:

• 00-19-03 A Medical Assistance Bulletin entitled Prioritization of Urgency of Need for Services (PUNS) Manual
• OMHSAS-19-02 A Medical Assistance Bulletin entitled Service Location Enrollment for Behavioral Health Providers
• 01-19-37 A Medical Assistance Bulletin entitled Prior Authorization of Antimigraine Agents, Other - Pharmacy Services
• 01-19-34 A Medical Assistance Bulletin entitled Prior Authorization of Acne Agents, Oral - Pharmacy Services
• 01-19-39 A Medical Assistance Bulletin entitled Prior Authorization of Antianginal Agents - Pharmacy Services 
  
• 01-19-38 A Medical Assistance Bulletin entitled Prior Authorization of Antimalarials - Pharmacy Services 
• 01-19-40 A Medical Assistance Bulletin entitled Prior Authorization of Angiotensin Modulators - Pharmacy Services
• 00-19-12 A Medical Assistance Bulletin entitled Notification Protocol for Formal Licensing Actions and Incidents
• OMHSAS-19-03 A Medical Assistance Bulletin entitled Serious Mental Illness: Adult Priority Group
• 01-19-27 A Medical Assistance Bulletin entitled Prior Authorization of Colony Stimulating Factors - Pharmacy Services 
• 01-19-22 A Medical Assistance Bulletin entitled Prior Authorization of Thalidomide and Derivatives - Pharmacy Services
• 01-19-26 A Medical Assistance Bulletin entitled Prior Authorization of HIV/AIDS Antiretrovirals - Pharmacy Services
• 01-19-24 A Medical Assistance Bulletin entitled Prior Authorization of Monoclonal Antibodies - Anti-IL, Anti-lgE (MABs - Anti-IL, anti-IgE) - Pharmacy Services
• 01-19-28 A Medical Assistance Bulletin entitled Prior Authorization of Cephalosporins - Pharmacy Services
• 01-19-25 A Medical Assistance Bulletin entitled Prior Authorization of Local Anesthetics, Topical - Pharmacy Services
• 01-19-23 A Medical Assistance Bulletin entitled Prior Authorization of Penicillins - Pharmacy Services
• 99-19-02 A Medical Assistance Bulletinentitled Pennsylvania's Early and Periodic screening, Diagnosis and Treatment (EPSDT) Program Periodicity Schedule
  
• 99-19-04 A Medical Assistance Bulletin entitled 2019 Healthcare Common Procedure Coding System(HCPCS) Updates, Fee Adjustments and Other Procedure Code Changes
• 01-19-32 A Medical Assistance Bulletin entitled Prior Authorization of Bone Density Regulators - Pharmacy Services
• 01-19-35 A Medical Assistance Bulletin entitled Prior Authorization of Antivirals, Herpes - Pharmacy Services
• 01-19-44 A Medical Assistance Bulletin entitled Prior Authorization of H. Pylori Treatments - Pharmacy Services
• 01-19-36 A Medical Assistance Bulletin entitled Prior Authorization of Antivirals, CMV - Pharmacy Services
• 01-19-33 A Medical Assistance Bulletin entitled Prior Authorization of Antivirals, influenza - Pharmacy Services
• 01-19-42 A Medical Assistance Bulletin entitled Prior Authorization of COPD Agents - Pharmacy Services
• 01-19-43 A Medical Assistance Bulletin entitled Prior Authorization of Antipsychotics - Pharmacy Services
• 01-19-30 A Medical Assistance Bulletin entitled Prior Authorization of Vaginal Anti-infectives - Pharmacy
  

7/18/19

Added MA Bulletin numbered:

• 01-19-15 A Medical Assistance Bulletin entitled  Prior Authorization of Antibiotics, Inhaled – Pharmacy Services
• 01-19-16 A Medical Assistance Bulletin entitled  Prior Authorization of Dupixent (dupilumab) – Pharmacy Services
• 01-19-17 A Medical Assistance Bulletin entitled  Prior Authorization of Immunomodulators, Atopic Dermatitis – Pharmacy
  
• 01-19-18 A Medical Assistance Bulletin entitled Prior Authorization of Xyrem (sodium oxybate) – Pharmacy Services
• 01-19-19 A Medical Assistance Bulletin entitled Prior Authorization of Complement Inhibitors – Pharmacy Services
• 01-19-20 A Medical Assistance Bulletin entitled Prior Authorization of Calcium Channel Blockers – Pharmacy Services
• 99-19-13 A Medical Assistance Bulletin entitled Diabetes Prevention Program Enrollment in the Medical Assistance Program
• 01-19-45 A Medical Assistance Bulletin entitled Medical Marijuana and State Licensure of Facilities and Agencies
• 01-19-46 A Medical Assistance Bulletin entitled Certified Recovery Specialists in Centers of Excellence

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Revisions to Participating Drug Company List for MA Drug Rebate
  
• Eligibility Verification System Issue
  

Added Remittance Advice Dates

• August 2019 Remittance Advice Dates
  

Added Managed Care Delivery System Subcommittee Meeting Agenda and Draft File Note - the July 2019 Managed Care Delivery System Subcommittee Agenda and Draft File Note have been posted and can be accessed from the Meeting Minutes archives page

6/20/19

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• 223 - Availability of the Provider Directory on the Department of Human Services Website

Added Medical Assistance Advisory Committee Meeting minutes - The May 2019 Medical Assistance Advisory Committee minutes have been posted and can be accessed from the Meeting Minutes archives page.

Added Managed Care Delivery System Subcommittee agenda and draft file note - The June 2019 Managed Care Delivery System Subcommittee agenda and May 2019 draft file note have been posted and can be accessed from the Meeting Minutes archives page.

5/23/19

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• 222 - New Electronic Benefit Transfer Card

Added Medical Assistance Advisory Committee Meeting agenda, minutes and attachments - The May 2019 Medical Assistance Advisory Committee agenda and April 2019 minutes and attachments have been posted and can be accessed from the Meeting Minutes archives page.

Added Managed Care Delivery System Subcommittee agenda and draft file note - The May 2019 Managed Care Delivery System Subcommittee agenda and April 2019 draft file note have been posted and can be accessed from the Meeting Minutes archives page.

Added the Fee-for-Service Subcommittee Meeting minutes - The May 2019 Fee-for-Service Subcommittee minutes have been posted and can be accessed from the Meeting Minutes archives page.

Added Pharmacy and Therapeutics Committee Meeting minutes - The November 2018 Pharmacy and Therapeutic Committee Meeting minutes have been posted and can be accessed from the Meeting Minutes archives page.

4/25/19

Added MA Bulletin numbered:

• 99-19-01 A Medical Assistance Bulletin entitled 2019 Recommended Childhood and Adolescent Immunization Schedule

Added Remittance Advice Alerts - The following Remittance Advice Alert/PROMISe™ Banner pages have been added to the website.

• Date of Death Recovery
  
• ESRD Transitional Drug Adjustment from Medicare

Added Medical Assistance Advisory Committee Meeting agenda, minutes and attachments - The April 2019 Medical Assistance Advisory Committee agenda and March 2019 minutes and attachments have been posted and can be accessed from the Meeting Minutes archives page.

4/11/19

Added MA Bulletin numbered:

• 01-19-11 A Medical Assistance Bulletin entitled Update to the Administration of the Human Papillomavirus (HPV) Vaccine

Added Remittance Advice Alert - The following Remittance Advice Alert/PROMISe™ Banner page has been added to the website.

• Revisions to Participating Drug Company list for Medicaid Drug Rebate Program

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• 221 - Common Billing Issues Which May Result in Denied Claims as of July 2019

Added Managed Care Delivery System Subcommittee agenda and draft file note - The April 2019 Managed Care Delivery System Subcommittee agenda and March 2019 draft file note have been posted and can be accessed from the Meeting Minutes archives page.

3/28/19

Added Remittance Advice Alert - The following Remittance Advice Alert/PROMISe™ Banner page has been added to the website.

• Fee-for-Service Relative Weight Adjustments
  

Added Medical Assistance Advisory Committee Meeting minutes, agenda, and attachments - The December 2018 and January and February 2019 Medical Assistance Advisory Committee minutes and March 2019 agenda and attachments have been posted and can be accessed from the Meeting Minutes archives page.

Added Consumer Subcommittee Meeting agenda and attachment - The March 2019 Consumer Subcommittee agenda and attachment have been posted and can be accessed from the Meeting Minutes archives page.

Added Drug Utilization Review Board minutes - The September 2018 Drug Utilization Review Board minutes have been posted and can be accessed from the Meeting Minutes archives page.

3/14/19

Added MA Bulletin numbered:

• 01-19-12 A Medical Assistance Bulletin entitled Changes to Third-Party Liability Requirements for Claims for Prenatal Services

Added Provider Quick Tip - The following Quick Tip has been added to the website.

• 220 - Version 36 of All Patient Refined-Diagnosis Related Group (APR DRG) Implementation

Added Managed Care Delivery System Subcommittee agenda, draft file note and attachment - The March 2019 Managed Care Delivery System Subcommittee agenda and February 2019 draft file note and attachment have been posted and can be accessed from the Meeting Minutes archives page.

2/28/19

Added Remittance Advice Alert - The following Remittance Advice Alert/PROMISe™ Banner page has been added to the website.

• Implementation of the All-Patient Refined Diagnosis Related Group version 36

Added Medical Assistance Advisory Committee Meeting agenda - The February 2019 Medical Assistance Advisory Committee agenda has been posted and can be accessed from the Meeting Minutes archives page.

Added the Fee-for-Service Subcommittee Meeting minutes - The February 2019 Fee-for-Service Subcommittee minutes have been posted and can be accessed from the Meeting Minutes archives page.

Added Managed Care Delivery System Subcommittee agenda and draft file note - The February 2019 Managed Care Delivery System Subcommittee agenda and January 2019 draft file note have been posted and can be accessed from the Meeting Minutes archives page.

Added Provider Quick Tips - The following Quick Tips have been added to the website.

• 219 - Service Location Enrollment Deadline

Added Medical Assistance Advisory Committee Meeting agenda and attachments - The January 2019 Medical Assistance Advisory Committee agenda and attachments have been posted and can be accessed from the Meeting Minutes archives page.

1/22/19

Added MA Bulletins numbered:

• 01-19-02 A Medical Assistance Bulletin entitled Prior Authorization of Symdeko (tezacaftor/ivacaftor) – Pharmacy Services
• 01-19-03 A Medical Assistance Bulletin entitled Prior Authorization of Radicava (edaravone) – Pharmacy Services
• 01-19-04 A Medical Assistance Bulletin entitled Preferred Drug List (PDL) Update January 28, 2019 - Pharmacy Services
• 01-19-05 A Medical Assistance Bulletin entitled Prior Authorization of Antihyperuricemics – Pharmacy Services
• 01-19-06 A Medical Assistance Bulletin entitled Prior Authorization of Anticonvulsants - Pharmacy Services
• 01-19-07 A Medical Assistance Bulletin entitled Prior Authorization of Pulmonary Arterial Hypertension (PAH) Agents, Oral and Inhaled – Pharmacy Services
• 01-19-08 A Medical Assistance Bulletin entitled Prior Authorization of Alpha-1 Proteinase Inhibitors – Pharmacy Services
• 01-19-09 A Medical Assistance Bulletin entitled Prior Authorization of Antiparkinson's Agents – Pharmacy Services
• 01-19-10 A Medical Assistance Bulletin entitled Prior Authorization of Multiple Sclerosis Agents – Pharmacy Services

Added Managed Care Delivery System Subcommittee agenda and draft file note - The January 2019 Managed Care Delivery System Subcommittee agenda and December 2018 draft file note have been posted and can be accessed from the Meeting Minutes archives page.