Reminder — CHIP Providers Required to Enroll with DHS

Effective Jan. 1, 2018, the Pennsylvania Department of Human Services (DHS) requires all care providers and practitioners to be enrolled to order, refer, or prescribe items or services for the state’s Children’s Health Insurance Program (CHIP) members. This requirement follows a Centers for Medicare & Medicaid Services (CMS) provision.

Providers who don’t meet this requirement and don’t have a valid PROMISe™ ID will have their claims denied for services provided to CHIP members.

CHIP providers must complete an enrollment application for their provider type for each location (office address) and submit all required documents to DHS.

You can sign up as a CHIP-only provider. And, most providers aren’t required to pay the application fee.

Other reminders:

• If you have already enrolled in the Pennsylvania Medical Assistance (MA) Program, you don’t need to re-enroll as a CHIP provider.
• If you are part of another state’s Medicaid or CHIP program, or are enrolled in Medicare, you must enroll with DHS to be a CHIP provider.
• If you see patients from multiple CHIP managed care organizations, you are only required to enroll once with DHS as a CHIP provider.
• If your practice has multiple locations, include each address on your application.

Note: If you have a PROMISe ID and you include any of the following providers on your request who don’t have a valid ID (National Provider Identifier – NPI), the claims will be denied:

• Billing provider
• Performing provider
• Referring provider

More information is available on the DHS’s website .