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The Office of Long-Term Living (OLTL) recently released a reminder to ensure that all agencies have correct contact information on file with them in accordance with § 52.14 (j)(1) (related to ongoing responsibilities of providers), which states that a provider shall notify the Department of Human Services’ (DHS) OLTL at least 30-days prior to changes in the provider’s address, telephone number, fax number, email address, provider name change, or provider’s designated contact person.

Additionally, it is imperative that the participant’s designated service coordinator’s correct information is included in the Home and Community Services Information System (HCSIS). Please ensure that the correct service coordinator’s (SC) name and contact information are accurate on each Individual Service Plan (ISP) assigned to them. OLTL uses this information to contact providers for many reasons specific to your agency, and it is important that members of their team have accurate information, as some of these contacts require immediate follow-up.

Please verify that your agency and staff member contact information is accurate and correct in HCSIS and PROMISe™ no later than 30 Days from Notice. If changes are needed to the SC and/or SC Supervisor contact on the Caseload Facesheet page, work with your agency’s designated Business Partner Administrator (BPA) and SC Supervisors to make the applicable changes to your agency’s caseload. If you are unsure of how to make those changes, all training materials are located in the HCSIS Learning Management System (LMS). If you do not have access to LMS, please contact your agency’s BPA.

To update your information with OLTL, complete the Change of Information form and send the completed form and any required supporting documents electronically.

If you have any questions regarding this communication, please contact the Division of Provider Operations, Enrollment and Certification Section inbox or call 800-932-0939, Option 1, Monday through Friday, 9:00 am – 12:00 pm and 1:00 pm – 4:00 pm.

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If providers have not already started implementing EVV, providers are at risk of being out of compliance on January 1, 2024.

All claims and encounters for HHCS are subjected to EVV requirements for dates of service on or after January 1, 2024 and must have a corresponding EVV visit, or claims payment will be impacted. Manual editing compliance rates will also go into effect on January 1, 2024. Please reference the recently released bulletin “Electronic Visit Verification Requirements for Home Health Care Services in the Fee-for-Services Delivery and Managed Care Delivery Systems Bulleting, number 05-22-09, 07-22-03, 54-22-01, 59-22-01, 00-22-06.”

The Department of Human Services (DHS) will continue to monitor EVV data. If any systemic issues occur, DHS will communicate the issue and resolution via the Listserv and the website as soon as they can. Support volume is expected to increase now through the end of January 2024. Please be aware that response times may be longer than normal during this time.

As a reminder, available resources are on the DHS EVV website. There is also an FAQ page, which may answer a majority of your questions as well.

EVV ERROR STATUS CODES

Error Status Codes (ESC) are actively setting for all claims with services subject to EVV that are submitted through PROMISe for fee-for-service programs. EVV ESCs are currently setting in a pay and list status, so while claims continue to pay, the ESC still sets to educate the provider. Providers should be actively reviewing these ESCs to determine if their claims and EVV data are matching appropriately. The EVV Error Status Codes (ESC) published on the DHS EVV website outlines the conditions when claims would deny beginning with dates of service January 1, 2024, and after.

  • ESC 936 sets when “Duplicate Matching EVV HHCS Visits Found.” When two exact EVV records exist in the aggregator, the claim validation call does not know which record to match with, so it will set either ESC 926 or ESC 936 and deny. To correct this issue for alternate EVV users, the EVV record should contain “BillVisit” set to “False.” This will tell the aggregator to set the duplicate record to “Omit” so it is not considered during EVV validation against the aggregator. In addition, alternate EVV users should ensure when sending records for omission that they submit the same “VisitOtherID” that was assigned to the original record they wish to omit/remove.
  • ESC 937 sets when “HHCS Units Billed Exceed Units Verified in EVV.” Provider agencies should determine if the units on the claim detail line or the units found in the EVV record need to be corrected. PROMISe™ is not designed to cut back units on the claim for an EVV service if the allowed units on the claim are greater than the total units found in the Aggregator. Providers should make corrections as applicable and resubmit the claim, ensuring the units found in the EVV Aggregator are equal to or greater than the units submitted on the claim. While performing claims resolution analysis, providers are encouraged to review the rounding rules and/or the calculation rules, make corrections accordingly, and resubmit the claim.
    • Note:“Allowed” units on a claim detail line are not always equal to the exact units submitted on the claim because other edits/audits are performed before the units on the claim are validated against the units found in the EVV Aggregator record. Example: Fiscal year unit limitations or weekly unit limitations may “cutback” units submitted on a claim which would make the units on the claim less than what was submitted on the actual claim.
  • If ESC 938, “No Matching HHCS EVV Visit Found,” is setting, providers should complete the following steps to determine the cause of the error:
    • If the EVV record that is found in the Aggregator contains a mismatch between one or more data elements on the claim, review the EVV record in the Aggregator and manually validate if the data elements found in the Aggregator record(s) contains the appropriate values as specified in the Alternate EVV technical specifications found on the DHS EVV website. A frequently seen error is when the EVV record contains a 9-digit MA ID # instead of the 10-digit Recipient ID number (RID) that is contained on the claim. If you experience this issue, update your client/participant number from 9 to 10-digits in your source system that feeds the alternate EVV system records that are sent to the aggregator.
    • For 2:1 services specifically, the system is unable to determine which care worker visit to use when calculating units if the aggregator contains overlapping time for 3 or more care workers. This scenario will typically occur during shift changes. To resolve this issue, the provider should manually adjust the third care worker’s EVV visit to a time that does not overlap with the care worker’s time whose shift is ending. Due to this system limitation, a manual edit for this scenario is acceptable by DHS.

Providers experiencing issues should reach out to the appropriate contacts, which are included below, based on the issues they are experiencing.

For technical issues, such as DHS Sandata account assistance, Welcome Kit reissuance, account unlock issues either for DHS Aggregator or DHS Sandata EVV, and/or issues with the DHS Aggregator accepting file submissions, please contact: Provider Assistance Center (PAC) or 800-248-2152.

For issues related to HHAeXchange and CHC billing, please contact HHAeXchange and/or the appropriate CHC-MCO.

For general EVV program issues or requests to be added to the EVV Listserv, please contact the EVV Resource Account.

For billing issues, such as why EVV ESCs are setting, what the EVV ESCs mean, and questions about what is in the Aggregator, please contact the following program office claims:

ODP Claims Resolution Section 1-866-386-8880,
Email
Hours of operation: Monday – Friday, 8:30 am –12:00 pm and 1:00 pm – 3:30 pm
OLTL Provider Call Center 1-800-932-0939

Hours of operation: Monday – Thursday, 9:00 am – 12:00 pm and 1:00 pm – 4:00 pm
OMAP Provider Inquiry Line 1-800-537-8862, choose option 2, then

option 6, then option 1

Hours of operation: Monday-Friday, 8:00 – 12:00 pm and 12:30 pm – 4:30 pm

 

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The Department of Human Services (DHS) is pleased to announce new provider enrollment portal enhancements designed to improve a provider’s enrollment experience. Providers will enter the enrollment portal from PROMISe™ using their existing registered login criteria. Upon successful login, providers will have access to these new enhancements:

  1. Applications for adding additional service locations, revalidations, and reactivations will prepopulate parts of your application;
  2. After logging into the portal, existing providers will be able to submit change requests to update their provider file without the need to complete a full application; and
  3. Proof of provider enrollment status with PA Medicaid is available to view and print.

See the PROMISe Quick Tips update for more information. If you do not have an existing login, please select “Register Now” in the Provider Login box and complete the process options. Additional enhancements are planned and will be communicated through future banner alerts and quick tips.

If you have further questions, please contact RCPA Policy Director Jim Sharp.

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ODP Announcement 22-025 serves to provide the hourly wage and benefits ranges for specific Participant Directed Services (PDS) for participants utilizing the Vendor Fiscal/Employer Agent (VF/EA) FMS model, effective March 1, 2022. The Office of Developmental Programs (ODP) updated the data used in establishing rates, which impacted the hourly wage and benefits ranges. The high end of the hourly wage and benefits ranges either increased or remained the same. There were no decreases to the high end of the hourly wage and benefits ranges. These wage and benefit ranges will be used to pay SSPs and to support claims processing in the Provider Reimbursement and Operations Management Information System in electronic format (PROMISe™) by the VF/EA FMS organization. This communication will only be updated when changes occur to the information contained within.

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ODP Announcement 21-093 is a reminder to all providers and vendors that provider revalidation occurs every 5 years from the initial enrollment date or most recent revalidation date of every service location. The Office of Developmental Programs (ODP) is seeing an increase in claim denials because providers fail to revalidate their service location(s) on time.

NOTE: If an MA or base provider does not complete revalidation by their revalidation date, they will not receive payment for service locations that are end dated and closed in PROMISe™. Claims will be denied and show as denied on their remittance advices. Reactivation of closed sites will be required prior to billing/payment resumption.

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In an effort to assist Infant/Toddler Programs and their contracted EI service providers to clear suspended claims from the PROMISe™ system, the Office of Child Development and Early Learning (OCDEL) has released guidance on the procedures for Early Intervention claim filing. Correct billing practices require adherence to correct filing procedures and time limits. All relevant information and instructions can be found in the PA PROMISe™ Provider Handbook for the 837 Professional/CMS-1500 Claim Form.

Time Limits for Claim Submission

DPW must receive claim forms for submissions, resubmissions, and adjustment of claim forms within specified time frames; otherwise, the claim will reject on timely filing related edits and will not be processed for payment.

Service providers (including service coordination entities) are required to submit original claims within 180 calendar days of the initial date of service. Claims which are received within 180-days of the date of service and subsequently denied may be resubmitted up to 365 calendar days from the original date of service.

Suspended Claims/180-Day Exception Request Process

ALL claims that are past the 180- or 365-billing day cycle AND directly associated to a reported PELICAN-EI systems issue are to be billed electronically through the PROMISe system. The claims filed will result in a “suspended” status. These suspended claims will be manually reviewed and approved by a Bureau of Early Intervention services staff member.

Approval of these suspended claims will require additional information submitted by the provider to the BEIS office via email. The email contents must include the following:

  • Provider name
  • MCI for the child
  • PELICAN-EI systems issue description and Help Desk Call Number

If the claim was suspended because it was past the filing limit and unrelated to a PELICAN-EI systems issue, you will need to provide an explanation for the delayed billing. Providing an explanation for the delayed billing will not automatically result in the claim being approved for payment. Each claim will be reviewed individually and considered for approval.

It is the responsibility of the billing entity to follow the requirements for timely billing as outlined in the PROMISe™ manual. Claims which have a suspended status will be denied unless the above procedures have been followed.

If you have any questions, please contact RCPA Children’s Policy Director Jim Sharp.

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