Provider Updates
2023
- 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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