Provider Updates
Attention, Providers:
We are aware that Change Healthcare’s outage has impacted some services for our providers, patients and members. We are continuing to work in collaboration with Change Healthcare to understand the extent of this incident. We recognize that this situation is disruptive and we are working on multiple solutions to restore provider functionality and ensure continuity of care for our members.
We will keep this page updated as the situation evolves to ensure you have access to the latest information and resources as we work to navigate the impact of this outage at https://www.centene.com/change-healthcare.html.
This page is broken down by topic and designed to help our members, patients, providers and customers navigate the impacts of the Change Healthcare outage.
Thank you for your patience and partnership as we navigate this situation together,
PA Health & Wellness
2024
- Upcoming Availity Live Webinars March 8, 2024 (PDF)
- Habiliation Auth Process Effective April 1, 2024 (PDF)
- DRG Inpatient Review Effective April 1, 2024 (PDF)
- Change Healthcare Incident Provider Alert 1 - 2.26.2024 (PDF)
- Medicare Part B Step Therapy Provider Notification Effective January 1, 2024 (PDF)
- Talk to your Participants about Medical Assistance Eligibility Renewal (PDF)
- Optum CPI C0037 C0038 Prepay Audit (PDF)
- Optum CPI X0150 MP027 Prepay Audit (PDF)
- Short Stay Reminder effective January 1, 2024 (PDF)
- NCD Non-Covered Lab Dx Notification (PDF)
- PA Health Wellness MSK FAQ (PDF)
- PA Health Wellness MSK QRG (PDF)
- Wellcare Policy Update MC.CP.MP.248 Facility based Sleep Studies for Obstructive Sleep Apnea (PDF)
- Medicare Blood Pressure Cuffs (PDF)
- Referwell Provider Communication (PDF)
- Evolent Webinar for PHW Providers (PDF)
- CY24 Provider Notification for Non-Formulary Drugs - WellCare by Allwell (PDF)
- NIA MSK Procedure Announcement (PDF)
- Effective 1.1.24 Medicare Medicare Updated Policies Final Rule 2024 (PDF)
2023
- Full Time Equivalent Form (PDF)
- Physician Certification Form (MA 570) Completion Reminder (PDF)
- Medicare Part B Step Therapy Provider Notification Effective January 1, 2024 (PDF)
- Important Pharmacy Claims Processing Change, Effective January 1, 2024 (PDF)
- Express Scripts FAQ (PDF)
- Provider Notification Optum CPI AMISYS Phase 5 (PDF)
- Ambetter Provider IET Initiation and Engagment of SUD (PDF)
- HHAeXchange Servicing Zip Code Changes (PDF)
- LTSS Provider Satisfaction Survey Save the Date (PDF)
- Small Business Survey 2023 (PDF)
- Provider Attribution Introduction September 2023 (PDF)
- Flu Prevention, 2023 (PDF)
- CNC Medicare PA List Changes, October 1, 2023 (PDF)
- HEDIS Blood Pressure Cuffs Reminder (PDF)
- Quick Reference Guide HEDIS® MY 2023 (PDF)
- Optum CPI AMISYS Phase 4 Effective October 1, 2023 (PDF)
- View our Provider Satisfaction Survey Save the Date (PDF).
- Habiliation Auth Process Provider Notification, August 1, 2023 (PDF)
- 72 Hour Rule Amisys and Xcelys, July 12, 2023 (PDF)
- Optum ER Surgical Services without Modifier 54, July 11, 2023 (PDF)
- Effective July 1, 2023: HHAeXchange Support Update Announcement (PDF)
- Effective August 14, 2023: PHW EVV Implementation for Home Health Care Services (HHCS), Posted June 23, 2023 (PDF)
- Attention Durable Medical Equipment (DME) Providers, June 9, 2023 (PDF)
- Termination of Somatus Care Management Program for Patients with CKD/ESRD, June 1, 2023 (PDF)
- PHW Provider Payment Policy Notification, June 1, 2023 (PDF)
- Medicare Auth List Changes, May 25, 2023 (PDF)
- Talk to Your Participants about Medical Assistance Eligibility Renewal, May 8, 2023 (PDF)
- PHW Provider Payment Policy Notification, May 5, 2023 (PDF)
- COVID-19 Medicare PHE Sunset Notice May 1, 2023 (PDF)
- Ambetter from PA Health & Wellness Fee Schedule Changes Updates Rates, April 12, 2023 (PDF)
- Ophthalmological Avastin Billing Reminder, March 7, 2023 (PDF)
- Hemodialysis Modifier and and Interim Claims, March 1, 2023 (PDF)
- Prepay Correct Coding ICD-10 Diagnosis Edits, March 1, 2023 (PDF)
- CI Enterprise Incident Management (EIM) Reminder, January 24, 2023 (PDF)
- Optum Prepayment Claims Reviews, January 17, 2023 (PDF)
- 2023 Partnership for Quality (P4Q) Provider Incentive Program Launch (PDF)
- Medicare Billing Reminders, Effective January 1, 2022 (PDF)
2022
- QIP Updates for 2023, December 29, 2022 (PDF)
- Ambetter NCQA Notification, November 30, 2022 (PDF)
- Effective January 1, 2023 - Medicare Part B Drug List, November 22, 2022 (PDF)
- Effective January 1, 2023 - Medicare Prior Authorization List, November 22, 2022 (PDF)
- LPN-RN Auth Reminder V.3 TTY Update, November 1, 2022 (PDF)
- Habilitation Auth Reminder, November 1, 2022 (PDF)
- EVV Provider Selection & the HHAeXchange Platform, October 6, 2022 (PDF)
- Claims Xten Optimization, August 21, 2022 (PDF)
- Final Q3 Reminder: Nursing Facility QIP Deliverables Due, September 5, 2022 (PDF)
- CHC versus HC Clarification, August 25, 2022 (PDF)
- Medicare Prior Auth Summary Effective October 1, 2022 (PDF)
- Medicare P2P and Inpatient Prior Auth Changes, August 1, 2022 (PDF)
- Nursing Facility Patient Pay Audits, July 6, 2022 (PDF)
- DME Update - June 9, 2022 (PDF)
- Critical Incident Reporting Update - June 8, 2022 (PDF)
- Wellcare by Allwell Authorization Updates - May 27, 2022 (PDF)
- Policy Updates - April 11, 2022 (PDF)
- EMR Access - April 12, 2022 (PDF)
- Claims & Payment Policy: Leg Stent Coding Updates - March 31, 2022 (PDF)
- 2022 Partnership for Quality (P4Q) Provider Incentive Program Launch (PDF)
2021
- Wellcare Billing Updates - December 23, 2021 (PDF)
- Prior Authorizations for Habilitation Services Reminder - December 6, 2021 (PDF)
- Wellcare Medicare IPM Provider Webinar Invite - November 15, 2021 (PDF)
- Wellcare Medicare Physical Medicine Provider Webinar Flyer - November 15, 2021 (PDF)
- WellCare Medical Specialty Solutions Provider Webinar Invite - November 15, 2021 (PDF)
- QSO-20-39-NH Nursing Home Visitation Revised November 11, 2021 (PDF)
- Allwell (Wellcare by Allwell) Medicare D-SNP Benefit Plan Package Coinsurance for Home Health/Hospice Services - October 11, 2021 (PDF)
- PA Wellcare by Allwell Brand Update - September 24, 2021 (PDF)
- DME Glove Rate Adjustment - July 1, 2021 (PDF)
- Provider Accessibility Initiative Letter - July 1, 2021 (PDF)
- Ambetter COVID-19 Prior Authorization Reinstatement - June 1, 2021 (PDF)
- Allwell COVID-19 Prior Authorization Reinstatement - June 1, 2021 (PDF)
- Continuity of Care Bonus Program (Formerly Pay for Performance) - May 21, 2021 (PDF)
- COVID-19 Telehealth Guidance for Providers - April 30, 2021 (PDF)
- DME Glove Rate Adjustment - April 1, 2021 (PDF)
- Medicare Blood Pressure Cuffs CBP Initiative - April 22, 2021 (PDF)
- Johnson and Johnson Vaccine Pause Alert - April 20, 2021 (PDF)
- Medicare Add-On Exclusions for Inpatient Claims Letter- April 5, 2021 (PDF)
- Medicare Part D Vaccination Claims - March 12, 2021 (PDF)
- COVID-19 Telehealth Guidance for Providers - January 26, 2021 (PDF)
- COVID-19 Telehealth Guidance for Providers - January 7, 2021 (PDF)
Commonwealth Coronavirus Resources
Federal Coronavirus Resources
Additional Coronavirus Resources
- Provider Accessibility Initiative COVID-19 Web Series
- COVID-19 and People with Disabilities
- Essential Services: Maintaining Access to Personal Attendants During the COVID-19 Epidemic
Additional Resources
2020
- Verifying Eligibility: HCBS/LTSS Benefits 12.28.2020 (PDF)
- COVID-19 Vaccine: Member Engagement Tips for Providers 12.11.2020 (PDF)
- PA Health and Wellness Provider Accessibility Initiative 12.15.2020 (PDF)
- COVID-19 Medicare Notice of Vaccine Billing Guidelines 12.2020 (PDF)
- COVID-19 Medicaid Notice of Vaccine Billing Guidelines 12.2020 (PDF)
- COVID-19 Marketplace Notice of Vaccine Billing Guidelines 12.2020 (PDF)
- Attention Nursing Facilities - Important Eligibility Reminder and Notice 12.7.2020 (PDF)
- Medicare Prior Auth List 2021 11.9.20 (PDF)
- Ambetter from PA Health & Wellness Physical Medicine QRG 9.2.20 (PDF)
- Ambetter from PA Health & Wellness Physical Medicine Provider FAQ 9.2.20 (PDF)
- Ambetter from PA Health & Wellness Physical Medicine Tip Sheet Checklist (PDF)
- NIA Expansion Letter (PDF)
- COVID-19 MA & Marketplace In Network COVID Care 10.23.20 (PDF)
- COVID-19 Public Health Emergency Period Extended - 10.12.20 (PDF)
- New Prepay Correct Coding ICD-10 Diagnosis Edits (PDF)
- PHW Flu Prevention Tips 9.17.2020 (PDF)
- EVV Communication - Effective 10.19.2020 (PDF)
- Transgender Therapy Virtual Sessions 2020 on 9-18, 10-16, 11-13, 12-11 (PDF)
- PHW DME Provider Training 8-21-2020 (PDF)
- COVID-19 Emergency Period Extended 7.28.2020 (PDF)
- DME Training FAQ 7-14-2020 (PDF)
- COVID-19 Public Health Emergency Period Extended 8-3-2020 (PDF)
- COVID-19 Billing Guidance for Testing, Screening, and Treatment 8-3-2020 (PDF)
- COVID-19 Telehealth Guidance 8-3-2020 (PDF)
- COVID-19 Medicare CARES DRG Increases 6-15-2020 (PDF)
- COVID-19 Medicare Cost Share Waivers Extension 6-3-2020 (PDF)
- HHAeXchange Guardrails Effective June 1, 2020 - 5-28-2020 (PDF)
- COVID-19 Billing Guidance for Testing Screening Treatment 5-13-20 (PDF)
- COVID-19 Provider Facing Web Content 5-13-20 (PDF)
- COVID-19 Telehealth Guidance for Providers 5-13-20 (PDF)
- Guidance on Hospital Responses to COVID-19 5-12-20 (PDF)
- COVID-19 Interim Nursing Facility Guidance 5-12-20 (PDF)
- COVID-19 PHW Authorization Instructions 5-7-20 (PDF)
- COVID-19 Personal Assistance Services Cheat Sheet for Providers 4-13-20 (PDF)
- COVID-19 Cheat Sheet for Providers 4-13-20 (PDF)
- PAI Executive Summary (PDF)
- COVID-19 Screening and Treatment Guidance for All Providers (PDF)
- COVID-19 Office of Mental Health and Substance Abuse FAQ's 3-25-20 (PDF)
- PA Department of Human Services, Front Line Worker during COVID-19 State of Emergency Document 3-26-20 (PDF)
- COVID-19 PA Health & Wellness Telehealth Guidance 3-24-2020 (PDF)
- COVID-19 Communication from National Imaging Associates (NIA) 3-16-2020 (PDF)
- COVID-19 Extended Coverage Announcement 3-12-20 (PDF)
- COVID-19 MA Coverage 3-11-20 (PDF)
- COVID-19 Guidance and Action 3-11-20 (PDF)
- COVID-19 Frequently Asked Questions 3-12-20 (PDF)
- COVID-19 In-Home Care Guidance 3-11-20 (PDF)
2019
- Medicare Beneficiary Identifier 11-7-19 (PDF)
- NF Update 10-17-19 (PDF)
- Appointment Availability 10-7-2019 (PDF)
- Provider Communications Payment Update 10-1-19 (PDF)
- PHW PDPM Guidance 10-1-19 (PDF)
- State Critical Incident Reporting Requirements 8-22-19 (PDF)
- Billing Update 6-28-19 (PDF)
- DRG Letter 3-29-19 (PDF)
- Provider Authorization Update 1-30-19 (PDF)
- Provider Communication - Authorizations in HHAeXchange 1-14-19 (PDF)
- Provider Communication - Billing and Claims 1-10-19 (PDF)
2018
- Provider Communication Policy Update 12-3-18 (PDF)
- Medicaid Payment Policy Update Inpatient Professional Claims 11-26-18 (PDF)
- Systemic Issue Causing CHC Disenrollment 7-2-18 (PDF)
- Updated Clinical Influenza and Streptococcus Group A 6-21-18 (PDF)
- Participant Winter Weather Alert 3-12-18 (PDF)
- Service Coordination Clarification 3-9-18 (PDF)
2017
- CHC Provider - Service Coordination 8-1-17 (PDF)
- CHC Provider - Service Coordination 8-1-17 (PDF)
- Understanding Community HealthChoices versus HealthChoices 7-7-17 (PDF)
- CHC Overview 7-17-17 (PDF)
- CHC Provider Third Party Liability 6-14-17 (PDF)
- CHC Provider Relationship 6-2-17 (PDF)