Provider Updates
2025
- CHC Prior Authorization Updates Effective September 2025 (PDF)
- Ambetter Prior Authorization Updates Effective September 2025 (PDF)
- PHW Pharmacist Provider Status How To Guide (PDF)
- 2025 Alternative Covered Drugs (PDF)
- Medicare PA Standardization List Effective July 2025 (PDF)
- Provider Notification Optum CPI April 2025 (PDF)
- Nursing Facility VBP April 2025 (PDF)
- Nursing Facility Incentive Extension March 2025 (PDF)
- OLTL Critical Incident Management Notification of Requirements Clarification (PDF)
- Ambetter Routine Foot Care Update (PDF)
- Nursing Facility Payment Incentive Update (PDF)
- Nursing Facility Retro Rate Adjment Q3-Q4 2024 (PDF)
2024
- EVV Compliance 85 Communication Effective January 1, 2025 (PDF)
- Evolent Cardiology Prior Authorizations and FAQs Effective March 1, 2025 (PDF)
- 2024 NCQA Accreditation Providing Quality Care (PDF)
- CHC Auto Assign Error November 26, 2024 (PDF)
- Availity Editing Service (PDF)
- Prescription Payment Program October 22, 2024 (PDF)
- PHW Provider Payment Policy Notification October 22, 2024 (PDF)
- Prior Authorization Supplemental Form (PDF)
- Ambetter Health Solutions to Begin January 1, 2025 (PDF)
- Electrodes for TENS Prepay Effective November 1, 2024 (PDF)
- Provider Satisfaction Survey Save the Date (PDF)
- Availity Transition Starting October 21, 2024 (PDF)
- CMS Two Midnight Rule June 27, 2024 (PDF)
- Inappropriate Place of Service for Ambulance Procedure Code (PDF)
- Medicare Member Reimbursement (PDF)
- NCD Reviews August 1, 2024 (PDF)
- Ambetter from PHW Notification of Pregnancy (PDF)
- Wellcare by Allwell 2024 Benefit Updates (PDF)
- Pre-auth Updates Effective July 1, 2024 (PDF)
- Reminder Home Health Notice of Admission (NOA) (PDF)
- Retro Ambulance Rate Change (PDF)
- Lab Policy Notice June 1, 2024 (PDF)
- Acaria Health Preferred Pharmacy (PDF)
- Concert Genetic Testing Payment Policy June 1, 2024 (PDF)
- PHW NCIL Barrier Removal Fund Information April 10, 2024 (PDF)
- 6 Degrees Health Introduction April 4, 2024 (PDF)
- NF Specialized Services Notice March 26, 2024 (PDF)
- 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)
2016
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