Provider Enrollment Required for
Services Delivered to CHIP Members

Enroll by Dec. 31, 2017, or Your CHIP Claims Won’t be Paid

Effective Jan. 1, 2018, the Pennsylvania Department of Human Services will implement a Patient Protection and Affordable Care Act of 2010 provision that requires Children’s Health Insurance Program (CHIP) care providers to be enrolled formally with the department. The provision applies to all providers who order, refer, or prescribe items or services to CHIP members, including Highmark members covered under a CHIP plan. 

Additionally, the provision requires that CHIP claims for payment include the provider’s National Provider Identifier.

As announced on Highmark’s NaviNet Plan Central page in August, providers who offer services to CHIP members must complete an enrollment application for their specific practitioner type for each service location/address and submit all required documents to the department.

To allow for timely processing of your application, all documents must be submitted to the department at least 60 days in advance of Dec. 31, 2017.

Please note that providers who:

  • Have already enrolled in the Pennsylvania Medical Assistance (MA) Program don’t need to enroll as a CHIP provider
  • Are part of another state’s Medicaid or CHIP Program, or who are enrolled in Medicare, must still enroll with the department as a CHIP provider
  • See CHIP patients at multiple locations must list each service location on their CHIP applications
  • Do not enroll by the December 31, 2017, deadline cannot render services to CHIP members, and Highmark cannot process the providers’ claims for those members.

More information, including details about the departments’ provider enrollment and screening process, can be found at http://dhs.pa.gov/provider/promise/enrollmentinformation/CHIPProEnrollInfo/index.htm . 

 

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