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    PROMISe

    PROMISe Certification

    PROMISe™ Provider/Payer Certification assures the compatibility between Providers and the Pennsylvania Medical Assistance Payer (PA Department of Human Services) when processing HIPAA transactions. This certification process confirms the ability of software products and users to submit readable, HIPAA compliant transactions. Certification cannot ensure that claims will be paid.

    Certification benefits submitters in many ways. Without certification, submitters have no assurance that their files will be accepted or processed correctly. Certification eliminates unnecessary processing and payment problems when the submitter begins to send production transactions.

    Certification is not intended to be used as the clearinghouse's, submitter's or software vendor's initial HIPAA testing. Each entity must complete its own internal testing prior to submitting transactions to Gainwell Technologies for PROMISe™/HIPAA certification. Providers and software developers are free to contract with third-party certification vendors individually for initial testing purposes. However, clearinghouses and submitters who certify through third-party certification vendors must also certify through Gainwell Technologies.

    If you are a New Trading Partner with PROMISe™, and wish to certify with the ANSI X12 v 5010 OR NCPDP Interactive D.0 or Batch 1.2, read the information below.

    Certification Informatoin for ANSI X12 & V5010 & NCPDP Interactive D.0 or Batch 1.2

    Certification requirements for submitters who are newly enrolled with PROMISe™ and need to complete ANSI X12 v 5010 or NCPDP vD.0 certification.

    Providers, clearinghouses and software vendors who are new submitters to PROMISe™ must complete a certification process in order to electronically submit HIPAA ANSI X12 v 5010 or NCPDP vD.0 Interactive and NCPDP v1.2 Batch transactions.

     

    Healthcare Claims Submission

    837 Submitters

    Clearinghouses and providers who will electronically submit to PROMISe™ 837 claims will be required to certify. Providers who submit claims through a clearinghouse are covered under the clearinghouse's certification. It is recommended that providers/submitters confirm with their respective clearinghouse that they, the clearinghouse, have taken proper measures to certify.

    276/277 Claim Status Request and Response

    Certification to submit 276 (Claim Status Inquiry) and receive 277 (Claim Status Response) in the 5010 format is automatically granted upon completion of 837 transaction certification.

     

    Eligibility Transactions

    270/271 Vendors, Interactive and Batch Submitters
    New Vendors must complete certification to submit 270 (Eligibility Benefit Inquiry) and receive 271 (Eligibility Benefit Response) in the 5010 format

     

    Pharmacy Claims

    NCPDP Vendors

    Software vendors and developers distributing software to providers are required to certify. Upon completion of the data release agreement and registration to certify, each vendor/developer will be assigned a Software Vendor ID. This software vendor ID is activated in production after certification is completed. The software vendor/developer will provide this number to users when distributing their software.

    NCPDP D.0 Interactive Submitters

    Submitters using certified software are covered under the software vendor's certification. Each user will submit their vendor's Software Vendor ID in the appropriate field of the NCPDP D.0 record to prove that they are using certified software. It is recommended that submitters ensure their software vendor has taken proper measures to certify.

    NCPDP 1.2 Batch Submitters
    Submitters using certified software are covered under the software vendor's certification. Each user will submit their vendor's Software Vendor ID in the appropriate field of the NCPDP 1.2 record to prove that they are using certified software. Additionally, each provider who will submit batch transactions using certified vendor software is responsible for obtaining an Gainwell Technologies HIPAA clearinghouse ID that grants access to the Gainwell Technologies clearinghouse system

    PROMISe™ Certification Steps

    837/835 Providers and Clearinghouses:

    1. Register for PROMISe™ certification via the PROMISe™ Certification Registration Form on the DHS Internet site.
    2. Receive certification packet from Gainwell Technologies.
    3. Submit certification test files.
    4. If issues are detected, the submitter will be required to make adjustments and resubmit the certification test file.
    5. Once a successful test is achieved, Gainwell Technologies will notify the provider. New providers will be assigned an Gainwell Technologies HIPAA Production ID; current providers will continue to use their HIPAA Production ID.

    270/271 and NCPDP Software Vendors and Developers

    1. Register for PROMISe™ certification via the PROMISe™ Certification Registration Form on the DHS Internet site.
    2. Receive certification packet from Gainwell Technologies.
    3. Submit certification test files.
    4. If issues are detected, the submitter will be required to make adjustments and resubmit the certification file.
    5. Once a successful test is achieved, Gainwell Technologies will notify the software vendor/developer and assign a Software Vendor ID (NCPDP) or terminal ID (270).

    270/271 and NCPDP Interactive and Batch Provider/Submitters

    These providers should contact their vendor and request certification. Additionally, batch submitters must register via the PROMISe™ Certification Registration Form on the DHS Internet site to obtain a clearinghouse ID. This last step is for batch submitters who have not already received an ID through the PA Medical Assistance HIPAA certification process.

    Certification Contact Information for NewPROMISe™ Submitters:

    For any questions/issues relating to registration or transaction test results, you may email or call with your questions to the following:

    1. Provider Assistance Center (PAC) papac1@gainwelltechnologies.com
    2. Provider Assistance Center (PAC) Phone Number: 717-975-4100 or 800-248-2152