Forms and information related to Direct Service Provider and Supports Coordination Organization billing and payment through PROMISe™. Foundational information provided on sound financial strategies. Training credit and Certificates of Achievement are NOT available in this category.
Billing and Payment (ID) – forms and information related to Direct Service Provider and Supports Coordination Organization billing and payment through PROMISe™. Foundational information provided on sound financial strategies. Training credit and Certificates of Achievement are NOT available in this category.
Webcasts provide information on financial strategies, business tools and techniques for Direct Service Providers and Supports Coordination Organizations.
The intention of these webcasts is to provide a reference tool for direct service providers and supports coordination organizations. As the Commonwealth of Pennsylvania’s Office of Developmental Programs works to support the transition to a fee-for-service environment, Dan Bradley, CPA provides information to be considered regarding financial strategies. Mr. Bradley has extensive experience in performing audits of for-profit, not-for-profit provider and governmental organizations.
For Direct Service Providers – billing, payment, and claims resolution resources specific to processing claim invoices for ODP.
In order for Office of Developmental Programs (ODP) direct service providers to receive payment for Waiver-Funded services rendered, they are required to submit their claim transactions through PROMISe (Provider Reimbursement and Operations Management Information System in electronic format). PROMISe is Pennsylvania’s dedicated claims processing system. PROMISe interfaces with the Home and Community Services Information System (HCSIS) to process Home and Community Based Service (HCBS) claim invoices for ODP.
The term claims processing is generally used to describe the series of activities and processes that occur systematically, based on claim criteria, to facilitate the accurate adjudication of claim data received by PROMISe. Claim payments are dependent on the providers ability to submit a claim successfully in order to ensure payments occur in a timely manner. In order for a provider to submit a claim successfully and be approved for payment, it is important that the provider understands the ODP billing process and rules surrounding it. The Provider Billing and Payment section contains billing, payment, and claims resolution resources specific to ODP. These resources support independent self-resolution activities by the provider. ODP strongly encourages direct service providers to attempt self-resolution of their claim errors.
Please visit the Provider Billing and Payment section often to obtain the latest version of provider billing resources and to view new resources currently under development. For assistance regarding claim issues, please contact the ODP Claims Resolution Section:
Toll Free Number: (866) 386-8880
Business Hours: Monday through Thursday 8:30am to 12:00pm and 1:00pm to 3:30pm
E-mail Address: ra-odpclaimsres@pa.gov
For TSM and SCO Services only – billing and payment resources and communication specific to claims processing including payment cycle information, identified issues, reprocessing tasks, updates and changes that would impact SCOs.
The Home and Community Services Information System (HCSIS) has been submitting claims for Targeted Services Management (TSM) services on behalf of ODP Supports Coordination Organizations (SCOs) since the implementation of Phase 2.0 release in HCSIS, which took place in August of 2002. As of July 1, 2008, Supports Coordination (SC) services became a discrete service from TSM and, as a result, HCSIS now submits claims for both services.
The term “claims processing” is generally used to describe the series of activities and processes that occur systematically, based on claim criteria, to facilitate the accurate adjudication of claim data received by PROMISe™. The Billing and Payment section contains billing and payment resources and communication specific to claims processing as it pertains to TSM and SC services only. This section was created so SCOs could easily locate resources and communications pertinent to claims. Some of the topics contained in this section include payment cycle information, identified issues, reprocessing tasks, updates and changes that would impact SCOs.
Please visit the Billing and Payment section of the SCOIC often to obtain the latest version of SCO billing resources, and to view new resources currently under development. For assistance regarding claim issues, please contact the ODP Claims Resolution Section:
Toll Free Number: (866) 386-8880
Business Hours: Monday through Thursday 8:30am to 12:00pm, and 1:00pm to 3:30pm
E-mail Address: ra-odpclaimsres@pa.gov
SCO – SC Billing Preparation (PDF)
December 9, 2021 Webinar