OMHSAS Division of Systems Management
The Division of Systems Management objective is to ensure eligible individuals can access behavioral health services covered by Medicaid and County Base-Funded Mental Health. This objective includes the management of various interacting state systems operations that ensures an individual can access services, management of the claim and/or encounter data, and conducting business intelligence activities with the behavioral health data received.
Information contained on this page is intended for the use of OMHSAS Behavioral Health business partners operating within HealthChoices and the County Mental Health Base Programs.
Contact Us
Listing below of all the relevant OMHSAS Division of Systems Management Resource Accounts
| OMHSAS Systems Division Resource Account | Description of inquiries that this resource account is designed to respond. |
|---|---|
| RA-PWOMHSAS837ISSUES@pa.gov | Questions related to Behavioral Health 837 institutional and professional encounters and all files outlined in Appendices M and O of the PS&R. |
| RA-PWOMHSAS834ISSUES@pa.gov | Questions related to Behavioral Health 834 transactions. |
| RA-PWELIGDISCREPANCY@pa.gov | Eligibility of individuals for Behavioral Health services |
| RA-PWELIGREFERENCE@pa.gov | Questions related to the Behavioral Health Services Reporting Classification Chart (BHSRCC). BHSRCC document is sent from the account. |
| RA-PWSERVICES@pa.gov | Provider enrollment |
| RA-PWICWC@pa.gov | Integrated Community Wellness Centers |
| RA-PW-BHMCOSecurity@pa.gov | Access to state systems by business partners |
| RA-PWOMHSASCCRIData@pa.gov | Questions related to Consolidated Community Reporting Initiative (CCRI) within County Base-Funded Mental Health |
Systems Notices
| Document Number | Title | Date Updated |
|---|---|---|
| OMHSAS 2020-001 | MMIS Communication | Feb. 10, 2020 |
| OMHSAS 2020-002 | Denial Log Instructions | March 11, 2020 |
| OMHSAS 2020-003 | Telehealth POS | March 23, 2020 |
| OMHSAS 2020-004 | COVID-19 CARC | April 3, 2020 |
| OMHSAS 2020-005 | COVID-19 CR Modifier DR Condition | Aug. 21, 2023 |
| OMHSAS 2020-006 | Service History and Pharmacy File | April 27, 2020 |
| OMHSAS 2020-007 | Cash Delinking | April 30, 2020 |
| OMHSAS 2020-008 | Reapplication File | Aug. 14, 2020 |
| OMHSAS 2020-009 | New Place of Service Codes | Oct. 30, 2020 |
| OMHSAS 2020-010 | Encounter Data Adjudication Date BES | Nov. 20, 2020 |
| OMHSAS 2020-011 | Encounter Data Adjudication Date BES Update | Dec. 4, 2020 |
| OMHSAS 2020-012 | Timely Encounters | Dec. 4, 2020 |
| OMHSAS 2020-013 | Behavioral Health Extensions During Cares Act | Dec. 9, 2020 |
| OMHSAS 2021-001 | Provider Files | March 22, 2021 |
| OMHSAS 2021-002 | Provider Files Update | April 8, 2021 |
| OMHSAS 2021-003 | Reserved | Reserved |
| OMHSAS 2021-004 | BH Extensions Override Manual Processes Discontinued | April 29, 2021 |
| OMHSAS 2021-005 | Service History File Field Additions June 2021 | June 16, 2021 |
| OMHSAS 2021-007 | Reserved | Reserved |
| OMHSAS 2021-008 | Reserved | Reserved |
| OMHSAS 2021-009 | NTE Segment — Modifier 95 | Nov. 4, 2021 |
| OMHSAS 2022-001 | Naloxone Take Home Supply — FQHCs/RHCs | April 4, 2022 |
| OMHSAS 2022-002 | PH HealthChoices MCO Plan Changes | Sept. 1, 2022 |
| OMHSAS 2022-003 | NTE Segment Changes | July 1, 2022 |
| OMHSAS 2023-001 | CAO Notification Form | Feb. 21, 2023 |
| OMHSAS 2023-002 | End of PHE System Edits | May 12, 2023 |
| OMHSAS 2023 - 003 | Voiding and Adjusting Encounters | July 07, 2023 |
| OMHSAS 2023 – 004 | Resuming Timely Encounter Submissions | July 26, 2023 |
| OMHSAS 2023 - 005 | Discontinuance of CR Modifier and DR Condition Code | Aug. 22, 2023 |
| OMHSAS 2023 - 006 | Error Status Code 519 | Sept. 14, 2023 |
| OMHSAS 2023 - 007 | Race Code Update -Z Code | Dec. 13, 2023 |
| OMHSAS 2024-001 | Encounter Data MCO Encounter Data Certifications | May 31, 2024 |
| OMHSAS 2024-002 | Service History Data Files – SUD Codes Systems Notice | May 31, 2024 |
Encounter Documents
| Program(s) | Document | Description | Date Updated |
|---|---|---|---|
| CCRI and HealthChoices | U277 Companion Guide | This Companion Guide contains information for interpreting unsolicited 277 transactions which are sent to notify managed care organizations (MCOs) about the status of their encounter data | June 2011 |
| An X12 999 Functional Acknowledgment | This report is generated for HIPAA transactions. A variety of errors can result in the transmittal of a 999 Functional Acknowledgment | April 2022 | |
| BES Report Layout Requirements | Business Exchange Services (BES) Report layout requirements | February 2018 | |
| ESC Supplemental Extract Layout | This output file is an extract of encounters which processed in PROMISe™for the previous day where the Paid or Denied Encounter set at least one PROMISe™ Error Status Code (ESC). | December 2018 | |
| File Layout for Diagnosis Code File | The document outlines for Diagnosis Code File layout. | December 2016 | |
| File Layout for PRV435 | This MA provider file will be supplied to each plan by DHS once a week. This file contains a listing of MA providers/service locations and special indicators | May 2021 | |
| List of Special Indicators | List of Special Indicator Codes | January 2018 | |
| File Layout for PRV720 | Provider Revalidation File (PRV720) File Layout | September 2021 | |
| BH Edit Crosswalks | PROMISe Edits for HealthChoices & CCRI/EPOMS Behavioral Health Encounters | October 2023 | |
| 834 Companion Guide | This Companion Guide contains detailed instructions for interpreting Benefit Enrollment and Maintenance (834) transaction records that can be received from PROMISe in the 834 format. | November 2023 | |
| SeGov Browser Instructions | This document represents a guide to the functionality available to the SeGOV Https Browser Users | March 2011 | |
| Program(s) | Document | Description | Date Updated |
| CCRI | CCRI Anonymous Consumers | Guidance for use of the Anonymous Consumer MHX Recipient Identification Number | Updated: July 2022 |
| CCRI ASC Attestation Statement | CCRI ASC Attestation Statement | March 2016 | |
| CCRI Edit Guide | CCRI Encounters Edit – Common Edits Information 718, 719, and 742 | March 2022 | |
| CCRI Reporting Tool | CCRI Reporting Tool | January 2024 | |
| CCRI Production Procedures | This guide is used to ensure the quality of data received will meet state and federal reporting requirements of client-level-data (CLD) | March 2022 | |
| CCRI PROMISe™Comprehensive Onboarding | A compendium of information related to the exchange of files between PROMISe™ | March 2022 | |
| CCRI PRV416 File Layout | Active and Closed Provider Service Locations with a PROMISe™ EPOMS Provider Eligibility Program on file | June 2019 | |
| CCRI NTE Technical Assistance | CCRI NTE Technical Assistance | October 2021 | |
| CCRI Encounters Webinar | CCRI Encounters Webinar PowerPoint | April 2022 | |
| CCRI Encounters Webinar Recording | CCRI Encounters Webinar Recording | April 2022 | |
| CCRI Encounters Webinar Q&A | CCRI Encounters Webinar Q&A | April 2022 | |
| SPS Services Reporting Procedures | This document outlines reporting procedures for services rendered under a Specialied Payment Structure | September 2023 | |
| SPS Services Template | File layout specificaitons | September 2023 |
CCRI-Specific System Notices
| Number | Title | Date Updated |
|---|---|---|
| CCRI 2021–001 | PRV720 PRV435 Communication | April 2021 |
| CCRI 2021–002 | NTE — Modifier 95 | Sept. 20, 2021 |
| CCRI 2022–001 | Reserved | Reserved |
| CCRI 2022–002 | Adding EPOMS PEP to an already existing service location | March 16, 2022 |
| CCRI 2022–003 | Provider Electronic Solutions Software (PES) | March 31, 2022 |
| CCRI 2023-001 | End of PHE System Edits | May 8, 2023 |
| CCRI 2023–002 | Voiding and Resubmitting Encounters | August 23, 2023 |
| CCRI 2023–003 | Discontinuance of CR Modifier DR Condition Codes | December 13, 2023 |
HealthChoices Reports
| Report Title | Description | Date Published |
|---|---|---|
| BH-MCO EDV Studies | OMHSAS conducted an Encounter Data Valdiation Study with each primary contractor’s respective BH-MCO | 2023 |
| BH-MCO Onsite Reports | OMHSAS conducts onsite reviews of the claim and encounter data submissions with each primary contractor’s respective BH-MCO | 2023 |
BH-MCO Onsite Reports
| OMHSAS conducts onsite reviews of the claim and encounter data submissions with each primary contractor’s respective BH-MCO | 2019 |
| COVID-19 Powerpoint Presentation | Powerpoint presentation of the various system changes in response to the COVID-19 public health emergency | April 2020 |
| COVID-19 Presentation Meeting Minutes | Questions and answers from the presentation in April 2020 | April 2020 |
| COVID-19 Presentation Attachments | Attachments provided as part of the presentation in April 2020 | April 2020 |
HealthChoices Provider Enrollment Documents
The table below contains links to applicable provider enrollment forms for Capitation Providers.
| PROMISe™ Provider Type (Code and Description) | Enrollment Documents |
|---|---|
| 07 - Capitation | Capitation Enrollment Application HC BH |
| Ownership and Control Document | |
| Guide: Requirements for Provider Type 07 - Capitation |