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 February 2019 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
PA21 Dec-11 PA21 - Attention Billing Directors, Billing Managers, and Billing Supervisors: Provider Online Enhancement Notification 430 KB PDF
PA20 Dec-11 PA20 - DSM V Diagnosis Codes 422 KB PDF
PA19 Dec-07 PA19 - Notification Regarding Change to Significant Member Incident Report Indicators 440 KB PDF
PA18 Nov-21 PA18 - Coordination with Single County Authority (SCA) Offices [North Central] 423 KB PDF
PA17 Nov-12 PA17 - Provider Online Enhancement Notification 422 KB PDF
PA16 Sep-25 PA16 - Provider Screening of Employees and Contractors for Exclusion from Participation in Medicaid 89 KB PDF
PA15 Sep-11 PA15 - Changes to the Complaint and Grievance Processes 87 KB PDF
PA14 Aug-28 PA14 - Change in Eligibility Process for Allegheny County Mental Health (ALMH) 73 KB PDF
PA13 Aug-28 PA13 - Change in Authorization Process: Psychiatric Rehabilitation 80 KB PDF
PA12 Jul-03 PA12 - Conversion from Pennsylvania Client Placement Criteria (PCPC) to American Society of Addiction Medicine (ASAM) 79 KB PDF
PA11 Jun-18 PA11 - Tobacco Cessation Counseling 77 KB PDF
PA10 May-29 PA10 - Peer Support Services (PSS) A Non-Compensable Service During Travel 76 KB PDF
PA09 May-17 Fraud, Waste & Abuse (FWA) Compliance & Program Integrity 2018 Policy Updates 62 KB PDF
PA08 May-04 Change in Authorization Process: Peer Support Services 66 KB PDF
PA07 May-04 New Requirements for Drug and Alcohol (D&A) Treatment Providers 65 KB PDF
MAT Learning Resource 92 KB PDF
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

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
2017 | 2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003