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Provider Manual and Alerts

The HealthChoices Provider Manual is designed to introduce you to Community Care and provide you with phone numbers as well as instruction regarding authorizations, billing, and quality of service.

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Provider Manual
Updated January 2018 Provider Manual 2270KB 124 pages PDF

Chapter 1101 of the Pennsylvania Code sets forth the Medical Assistance regulations and policies which apply to providers. Regulations specific to each type of provider are located in the separate chapters relating to each provider type. View Chapter 1101 of the Pennsylvania Code.

Throughout the year we issue Provider Alerts which are official updates to the main manual. Alerts apply to all counties except where noted.

2018 Provider Alerts
PA06 Feb-13 Community Care Provider Fraud, Waste & Abuse (FWA) Training Requirement 75 KB PDF
PA05 Feb-13 Change in BHRS TSS Schedule Submission 69 KB PDF
PA04 Feb-13 Change of Address for Dubois Office [North Central] 79 KB PDF
PA03 Feb-13 CMS Issuing New Medicare Cards and New Medicare Numbers 74 KB PDF
PA02 Jan-09 Change in Precertification Process for Inpatient Non-Hospital Detoxification (3A) Services 81 KB PDF
PA01 Jan-01 Claim Requirements CMS-1500 & 837P Fields/UB-04 &8371: Ordering, Referring, or Prescribing Physician 116 KB PDF

2017 Provider Alerts
PA17 Nov-10 Revised Rate Setting Policy [Except HealthChoices Northeast] 74 KB PDF
ADM017 Provider Rate Setting Policy and Procedure Manual 34 KB PDF
PA16 Oct-19 Treatment Plan Documentation Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) 74 KB PDF
PA15 Sept-01 Change in Authorization Process [Chester] 74 KB PDF
PA14 Aug-07 Change in Authorization Process 100 KB PDF
PA13 Jul-25 Change in Authorization Process [Allegheny] 75 KB PDF
PA12 Jun-21 PROMISe Enrollment Required for All Ordering, Referring, or Prescribing Practitioners
ORP Survey (XLSX, 11KB)
PA11 Jun-21 Peer Support Services - Youth 14 Years of Age and Older 76 KB PDF
PA10 May-24 Change of Address for Camp Hill Office [Adams/Berks/York] 73 KB PDF
PA09 Apr-28 Fraud, Waste & Abuse (FWA) Compliance & Program Integrity Update 71 KB PDF
PA08 Apr-28 Change in Authorization Process: Allegheny County Drug and Alcohol (ALDA) 59 KB PDF
PA07 Apr-28 Member Eligibility Verification Via ePortal 64 KB PDF
PA06 Apr-28 Change In Eligibility Process For Allegheny County Drug And Alcohol (ALDA) 65 KB PDF
PA05 Apr-21 Change in Precertification Process for Inpatient Non-hospital Detoxification (3A) Services 68 KB PDF
PA04 Mar-03 PROMISe Enrollment - Financial Impact 68 KB PDF
PA03 Feb-28 Change of Address for Williamsport Office [Lycoming/Clinton] 55 KB PDF
PA02 Feb-13 New Required Documents for Continued Stay Requests for Child/Adolescent Partial Hospitalization Programs (PHP) [York/Adams/Berks] 62 KB PDF
PA01 Feb-13 New Provider Manual 55 KB PDF

2016 Provider Alerts
PA16 Oct-12 Encounter Form Requirements 83 KB PDF
PA15 Oct-11 Enhanced Outpatient Services: Change in Authorization Rules [Allegheny] 210 KB PDF
PA14 Sep-30 Performance Standards for Psychiatric Rehabilitation Services 187 KB PDF
PA13 Sep-30 BHRS Providers: New Plan of Care Requirements for Applied Behavior Analysis (ABA) 73 KB PDF
PA12 Sep-30 BHRS Providers: New Billing Codes for Applied Behavior Analysis (ABA) [North East] 78 KB PDF
PA11 Sep-30 BHRS Providers: New Billing Codes for Applied Behavior Analysis (ABA) [Chester] 78 KB PDF
PA10 Sep-30 BHRS Providers: New Billing Codes for Applied Behavior Analysis (ABA) [All Counties except North East & Chester] 81 KB PDF
PA09 Sep-20 New Termination Procedure for Blended/Intensive/Resource Coordination Case Management for Adults and Child/Adolescents 405 KB PDF
PA08 Sep-06 Electronic Authorization Reports Replacing Paper Authorization Reports for Practitioners Effective September 19, 2016 301 KB PDF
PA07 Aug-02 Notification to North Central State Option Providers Regarding Revisions to TCM Performance Standards [North Central] 67 KB PDF
PA06 Aug-01 Community Care ePortal Users Required to Use Current Industry-Standard Web Browsers 94 KB PDF
PA05 Jul-08 Change in Frequency: Collection of Outcomes for Children and Families Receiving Behavioral Health Rehabilitation Services (BHRS) and Community and School Based Behavioral Health Services (CSBBH) 250 KB PDF
PA04 Jul-01 Training Requirements for Licensed Behavior Specialists Who Use Behavioral Specialist Consultant - Autism Spectrum Disorder Services to Provide Applied Behavior Analysis 243 KB PDF
PA03 Mar-10 HealthChoices Erie Initial ISPT Meetings for BHRS Services [Erie] 227 KB PDF
Mar-10 BHRS Capacity Report Template 12 KB XLSX
PA02 Feb-22 Prescription of Naloxone 90 KB PDF
PA01 Jan-25 January 28, 2016 Outpatient Registration & POMS Transition 85 KB PDF

2015 Provider Alerts
PA19 Dec-18 PROMISe Enrollment Application Submission Deadline Approaching 290 KB PDF
PA18 Dec-01 Change in Outpatient Registration Process for Practitioners 69 KB PDF
PA17 Nov-03 Change in Outpatient Registration Process for Facilities 258 KB PDF
PA16 Oct-28 Providers of Drug & Alcohol Services Coordination With Single County Authority (SCA) Offices [Lycoming/Clinton] 235 KB PDF
PA15 Sep-16 ICD-10 Implementation Reminders 255 KB PDF
PA14 Sep-16 Appropriate Use of Diagnosis Code F99 77 KB PDF
PA13 Aug-10 Providers of Drug & Alcohol Services Coordination with Single County Authority (SCA) Offices [North Central] 242 KB PDF
PA12 Aug-04 Interpretation Services [Erie] 237 KB PDF
PA11 Aug-04 Re-Enrollment/Revalidation of Medical Assistance Providers 215 KB PDF
PA10 Aug-04 Encounter Forms for Mobile Services 223 KB PDF
PA09 July-24 ICD-10 Implementation 86 KB PDF
PA08 July-24 Submitting Diagnoses on Authorization Requests 68 KB PDF
PA07 July-10 Change of Address for Community Care Administrative Office [Blair] 66 KB PDF
PA06 July-07 Changes to Online Authorization Request Forms 241 KB PDF
PA05 June-18 Coordination of Benefits Timely Filing Changes 74 KB PDF
PA04 June-18 Discontinuation of Paper Outpatient Registration Forms 68 KB PDF
PA03 May-05 Treatment Plan Definitions 78 KB PDF
PA02 Feb-24 Eligibility Changes Related to Healthy PA 237 KB PDF
PA01 Jan-14 Individuals Enrolled Incorrectly in Healthy PA Private Coverage Option (PCO) Plans 85 KB PDF

The information in Provider Alerts prior to 2009 is included in the Provider Manual at the top of the page. The archive below is available for your convenience.

Archive of Provider Alerts
2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003