Skip to agency navigation
Skip to main content

Official Website

of the Commonwealth of Pennsylvania

    The .gov means its official.

    Local, state, and federal government websites often end in .gov. Commonwealth of Pennsylvania government websites and email systems use "pennsylvania.gov" or "pa.gov" at the end of the address. Before sharing sensitive or personal information, make sure you're on an official state website. 

    Local, state, and federal government websites often end in .gov. Commonwealth of Pennsylvania government websites and email systems use "pennsylvania.gov" or "pa.gov" at the end of the address. Before sharing sensitive or personal information, make sure you're on an official state website. 

    Local, state, and federal government websites often end in .gov. Commonwealth of Pennsylvania government websites and email systems use "pennsylvania.gov" or "pa.gov" at the end of the address. Before sharing sensitive or personal information, make sure you're on an official state website. 

    Local, state, and federal government websites often end in .gov. Commonwealth of Pennsylvania government websites and email systems use "pennsylvania.gov" or "pa.gov" at the end of the address. Before sharing sensitive or personal information, make sure you're on an official state website. 

    Local, state, and federal government websites often end in .gov. Commonwealth of Pennsylvania government websites and email systems use "pennsylvania.gov" or "pa.gov" at the end of the address. Before sharing sensitive or personal information, make sure you're on an official state website. 

    Local, state, and federal government websites often end in .gov. Commonwealth of Pennsylvania government websites and email systems use "pennsylvania.gov" or "pa.gov" at the end of the address. Before sharing sensitive or personal information, make sure you're on an official state website. 

    Local, state, and federal government websites often end in .gov. Commonwealth of Pennsylvania government websites and email systems use "pennsylvania.gov" or "pa.gov" at the end of the address. Before sharing sensitive or personal information, make sure you're on an official state website. 

    Local, state, and federal government websites often end in .gov. Commonwealth of Pennsylvania government websites and email systems use "pennsylvania.gov" or "pa.gov" at the end of the address. Before sharing sensitive or personal information, make sure you're on an official state website. 

    Local, state, and federal government websites often end in .gov. Commonwealth of Pennsylvania government websites and email systems use "pennsylvania.gov" or "pa.gov" at the end of the address. Before sharing sensitive or personal information, make sure you're on an official state website. 

    Local, state, and federal government websites often end in .gov. Commonwealth of Pennsylvania government websites and email systems use "pennsylvania.gov" or "pa.gov" at the end of the address. Before sharing sensitive or personal information, make sure you're on an official state website. 

     
    Behavioral HealthChoices

    Systems Management

    OMHSAS Division of Systems Management

    The Division of Systems Management objective is to ensure eligible individuals can access behavioral health services covered by Medicaid and County Base-Funded Mental Health. This objective includes the management of various interacting state systems operations that ensures an individual can access services, management of the claim and/or encounter data, and conducting business intelligence activities with the behavioral health data received.

    Information contained on this page is intended for the use of OMHSAS Behavioral Health business partners operating within HealthChoices and the County Mental Health Base Programs.

    Contact Us

    Listing below of all the relevant OMHSAS Division of Systems Management Resource Accounts

    ​OMHSAS Systems Division Resource Account
    		​Description of inquiries that this resource account is designed to respond.
    RA-PWOMHSAS837ISSUES@pa.gov
    		​Questions related to Behavioral Health 837 institutional and professional encounters and all files outlined in Appendices M and O of the PS&R.
    ​RA-PWOMHSAS834ISSUES@pa.gov
    		​Questions related to Behavioral Health 834 transactions.
    ​RA-PWELIGDISCREPANCY@pa.gov
    		​Eligibility of individuals for Behavioral Health services
    ​RA-PWELIGREFERENCE@pa.gov
    		​Questions related to the Behavioral Health Services Reporting Classification Chart (BHSRCC). BHSRCC document is sent from the account. 
    ​RA-PWSERVICES@pa.gov
    		​Provider enrollment
    ​RA-PWICWC@pa.gov
    		​Integrated Community Wellness Centers
    ​RA-PW-BHMCOSecurity@pa.gov
    		​Access to state systems by business partners
    ​RA-PWOMHSASCCRIData@pa.gov
    		​Questions related to Consolidated Community Reporting Initiative (CCRI) within County Base-Funded Mental Health  

     

    Systems Notices

    Document NumberTitleDate Updated
    OMHSAS 2020-001MMIS CommunicationFeb. 10, 2020
    OMHSAS 2020-002Denial Log InstructionsMarch 11, 2020
    OMHSAS 2020-003Telehealth POSMarch 23, 2020
    OMHSAS 2020-004COVID-19 CARCApril 3, 2020
    OMHSAS 2020-005COVID-19 CR Modifier DR ConditionAug. 21, 2023
    OMHSAS 2020-006Service History and Pharmacy FileApril 27, 2020
    OMHSAS 2020-007Cash DelinkingApril 30, 2020
    OMHSAS 2020-008Reapplication FileAug. 14, 2020
    OMHSAS 2020-009New Place of Service CodesOct. 30, 2020
    OMHSAS 2020-010Encounter Data Adjudication Date BESNov. 20, 2020
    OMHSAS 2020-011Encounter Data Adjudication Date BES UpdateDec. 4, 2020
    OMHSAS 2020-012Timely Encounters Dec. 4, 2020
    OMHSAS 2020-013Behavioral Health Extensions During Cares ActDec. 9, 2020
    OMHSAS 2021-001Provider FilesMarch 22, 2021
    OMHSAS 2021-002Provider Files UpdateApril 8, 2021
    OMHSAS 2021-003ReservedReserved
    OMHSAS 2021-004BH Extensions Override Manual Processes DiscontinuedApril 29, 2021
    OMHSAS 2021-005Service History File Field Additions June 2021June 16, 2021
    OMHSAS 2021-007ReservedReserved
    OMHSAS 2021-008ReservedReserved
    OMHSAS 2021-009NTE Segment — Modifier 95Nov. 4, 2021
    OMHSAS 2022-001Naloxone Take Home Supply — FQHCs/RHCsApril 4, 2022
    OMHSAS 2022-002PH HealthChoices MCO Plan ChangesSept. 1, 2022
    OMHSAS 2022-003NTE Segment ChangesJuly 1, 2022
    OMHSAS 2023-001CAO Notification FormFeb. 21, 2023
    OMHSAS 2023-002End of PHE System EditsMay 12, 2023
    OMHSAS 2023 - 003Voiding and Adjusting EncountersJuly 07, 2023
    OMHSAS 2023 – 004Resuming Timely Encounter SubmissionsJuly 26, 2023
    OMHSAS 2023 - 005Discontinuance of CR Modifier and DR Condition CodeAug. 22, 2023
    OMHSAS 2023 - 006Error Status Code 519Sept. 14, 2023
    OMHSAS 2023 - 007Race Code Update -Z CodeDec. 13, 2023
    OMHSAS 2024-001Encounter Data MCO Encounter Data CertificationsAugust 1, 2024
    OMHSAS 2024-002Service History Data Files – SUD Codes Systems NoticeMay 31, 2024
    OMHSAS 2024-003Screening for Depression (CDF) G CodesJuly 1, 2024

     

    Encounter Documents

    Program(s)DocumentDescriptionDate Updated
    CCRI and HealthChoicesU277 Companion GuideThis Companion Guide contains information for interpreting unsolicited 277 transactions which are sent to notify managed care organizations (MCOs) about the status of their encounter dataJune 2011
    An X12 999 Functional AcknowledgmentThis report is generated for HIPAA transactions. A variety of errors can result in the transmittal of a 999 Functional AcknowledgmentApril 2022
    BES Report Layout RequirementsBusiness Exchange Services (BES) Report layout requirementsFebruary 2018
    ESC Supplemental Extract LayoutThis output file is an extract of encounters which processed in PROMISe™for the previous day where the Paid or Denied Encounter set at least one PROMISe™ Error Status Code (ESC).December 2018
    File Layout for Diagnosis Code FileThe document outlines for Diagnosis Code File layout.December 2016
    File Layout for PRV435This MA provider file will be supplied to each plan by DHS once a week.  This file contains a listing of MA providers/service locations and special indicatorsMay 2021
    List of Special IndicatorsList of Special Indicator CodesJanuary 2018
    File Layout for PRV720Provider Revalidation File (PRV720) File LayoutSeptember 2021
    BH Edit CrosswalksPROMISe Edits for HealthChoices & CCRI/EPOMS Behavioral Health EncountersOctober 2023
    834 Companion GuideThis Companion Guide contains detailed instructions for interpreting Benefit Enrollment and Maintenance (834) transaction records that can be received from PROMISe in the 834 format.November 2023
    SeGov Browser InstructionsThis document represents a guide to the functionality available to the SeGOV Https Browser UsersMarch 2011
    Program(s)DocumentDescriptionDate Updated
    CCRICCRI Anonymous ConsumersGuidance for use of the Anonymous Consumer MHX Recipient Identification NumberUpdated: July 2022
    CCRI ASC Attestation StatementCCRI ASC Attestation StatementMarch 2016
    CCRI Edit GuideCCRI Encounters Edit – Common Edits Information 718, 719, and 742March 2022
    CCRI Reporting ToolCCRI Reporting ToolJuly 2024
    CCRI Production ProceduresThis guide is used to ensure the quality of data received will meet state and federal reporting requirements of client-level-data (CLD)March 2022
    CCRI PROMISe™Comprehensive OnboardingA compendium of information related to the exchange of files between PROMISe™March 2022
    CCRI PRV416 File LayoutActive and Closed Provider Service Locations with a PROMISe™ EPOMS Provider Eligibility Program on fileJune 2019
    CCRI NTE Technical AssistanceCCRI NTE Technical AssistanceOctober 2021
    CCRI Encounters WebinarCCRI Encounters Webinar PowerPoint April 2022
    CCRI Encounters Webinar Recording​CCRI Encounters Webinar RecordingApril 2022
    CCRI Encounters Webinar Q&ACCRI Encounters Webinar Q&AApril 2022
    SPS Services Reporting ProceduresThis document outlines reporting procedures for services rendered under a Specialied Payment StructureSeptember 2023
    SPS Services TemplateFile layout specificaitonsSeptember 2023

     

    CCRI-Specific System Notices

    NumberTitle Date Updated
    CCRI 2021–001PRV720 PRV435 CommunicationApril 2021
    CCRI 2021–002NTE — Modifier 95Sept. 20, 2021
    CCRI 2022–001ReservedReserved
    CCRI 2022–002Adding EPOMS PEP to an already existing service locationMarch 16, 2022
    CCRI 2022–003Provider Electronic Solutions Software (PES)March 31, 2022
    CCRI 2023-001End of PHE System EditsMay 8, 2023
    CCRI 2023–002Voiding and Resubmitting EncountersAugust 23, 2023
    CCRI 2023–003Discontinuance of CR Modifier DR Condition CodesDecember 13, 2023

     

    HealthChoices Reports

    Report TitleDescriptionDate Published
    BH-MCO EDV Studies OMHSAS conducted an Encounter Data Valdiation Study with each primary contractor’s respective BH-MCO2023
    BH-MCO Onsite Reports OMHSAS conducts onsite reviews of the claim and encounter data submissions with each primary contractor’s respective BH-MCO2023

    BH-MCO Onsite Reports

     

     

    		OMHSAS conducts onsite reviews of the claim and encounter data submissions with each primary contractor’s respective BH-MCO2019
    COVID-19 Powerpoint PresentationPowerpoint presentation of the various system changes in response to the COVID-19 public health emergencyApril 2020
    COVID-19 Presentation Meeting MinutesQuestions and answers from the presentation in April 2020April 2020
    COVID-19 Presentation AttachmentsAttachments provided as part of the presentation in April 2020April 2020

     

    HealthChoices Provider Enrollment Documents

    The table below contains links to applicable provider enrollment forms for Capitation Providers.

    PROMISe™ Provider Type (Code and Description)Enrollment Documents
    07 - CapitationCapitation Enrollment Application HC BH
    Ownership and Control Document
    Guide: Requirements for Provider Type 07 - Capitation