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PENNSYLVANIA MA PROVIDER NUMBERS

If the MA ID on your most recent Schedule A is different than the one you received from OMAP or if there are any other questions about your Schedule A, please notify your Provider Representative as soon as possible. This will enable us to make any necessary changes to the Schedule A forms before they are issued again.

(Chart revised 10/8/2004)

Providers are asked to refer to the Schedule A's attached to their contracts for billing with HIPAA compliant codes.

HIPAA (PROMISe) Place of Service Notice from the OMAP Website 3/5/04

Pricing and Information Modifier Descriptions

          Download modifier def.xls (MS Excel)

• Browser Interface Manual

• EDI Browser Connection Phone Number

  (215) 413-3178

• Sample Trading Partner Agreement (TPA)

• CBH Companion Guide 837 Professional (revised 10/15/04)

• CBH Companion Guide 837 Institutional (revised 10/15/04)

• National Implementation Guides

• Diagram of the CBH EDI Claims Submission Process

Forms for paper claims submission

• Sample UB 92

• Sample CMS 1500