Policies and Notices
PerformCare policies and procedures
PerformCare policies posted to this website are updated annually. It is possible a more current version of a policy is available. Please contact your Account Representative or Care Manager for such policy inquiries.
CC-001: Reporting Suspected Provider Fraud, Waste, and Abuse (PDF) September 13, 2018
Attachments
- CC-001-01: Attachment 1: MCO Fraud, Waste, and Abuse Reporting Requirements (PDF) September 13, 2018
- CC-001-02: Attachment 2: BPI MCO Referral Form (PDF) September 13, 2018
- CC-001-03: Attachment 3: BPI MCO Referral Supporting Documentation Checklist (PDF) September 13, 2018
CC-002: Fraud, Waste, and Abuse Program (PDF) September 5, 2017
Attachments
- CC-002-01: Attachment 1: MCO Fraud, Waste, and Abuse Reporting Requirements (PDF) September 5, 2017
- CC-002-02: Attachment 2: BPI MCO Referral Form (PDF) September 5, 2017
- CC-002-03: Attachment 3: Fraud, Waste, and Abuse (FWA) Plan (PDF) September 5, 2017
CC-003: Provider Audits Conducted by the Special Investigation Unit (PDF) December 21, 2018
Attachments
- CC-003-01: Attachment 1: Special Investigation Unit Recovery Audit Spreadsheet (PDF) December 21, 2018
- CC-003-02: Attachment 2: Case Summary Report (PDF) December 21, 2018
- CC-003-03: Attachment 3: Special Investigation Unit Recovery Letter (PDF) December 21, 2018
CC-005: Provider Dispute Policy (PDF) June 8, 2018
Attachments
- CC-005-01: Attachment 1: Special Investigation Unit Audit Spreadsheet (PDF) June 8, 2018
- CC-005-02: Attachment 2: Special Investigation Unit Overpayment Letter (PDF) June 8, 2018
- CC-005-03: Attachment 3: Special Investigation Unit First-Level Dispute Response Letter (PDF) June 8, 2018
- CC-005-04: Attachment 4: Special Investigation Unit Second-Level Dispute Response Letter (PDF) June 8, 2018
CC-006: Payment Adjustments for Provider-Preventable Conditions Including Health Care-Acquired Conditions (HCACs) (PDF) September 11, 2018
Attachments
- CC-006-01: Attachment 1: Federal Register: Medicare Programs; Payment Adjustment for Provider-Preventable Conditions Including Health Care-Acquired Conditions (PDF) September 11, 2018
- CC-006-02: Attachment 2: Medical Assistance Bulletin: Provider-Preventable Conditions (PDF) September 11, 2018
- CC-006-03: Attachment 3: Medicare/Medicaid HCACs for FY 2011 (PDF) September 11, 2018
CC-012: Recipient Verification of Services (PDF) September 11, 2018
Attachment
- CC-012-01: Recipient Verification of Services Sample Recipient Verification Letter (PDF) September 11, 2018
CM-006: Documentation Standards for Providers (PDF) July 1, 2007
Attachment
CM-007: Service Denial Behavioral Health Inpatient Services (PDF) November 19, 2018
CM-009: Use of IQ and Adaptive Functioning Testing to Diagnose Mental Retardation (PDF) January 1, 2004
Attachments
- CM-009-02: Attachment 2: Office of Mental Health and Substance Abuse Services Policy Clarification — #02-04 (PDF)
- CM-009-03: Attachment 3: Office of Mental Health and Substance Abuse Services Policy Clarification — #03-03 (PDF)
CM-011: Clinical Care Management Decision Making (PDF) November 19, 2018
CM-012: Authorization of Psychological and Neuropsychological Testing (PDF) November 6, 2018
Attachments
- CM-012-01: Attachment 1: Psychological and Neuropsychological Testing Request Form (PDF) November 6, 2018
- CM-012-02: Attachment 2: Guidelines for Psychological Testing (PDF) November 21, 2018
- CM-012-03: Attachment 3: Guidelines for Psychological/Neuropsychological Tests and Times For Administration, Scoring, Interpretation, and Report (PDF) November 21, 2018
CM-013: Denial Notice Procedure (PDF) December 1, 2006
CM-019: Bed Hold Payment and Therapeutic Leaves (PDF) December 1, 2006
CM-020: Provider Notification to PerformCare of Inpatient Stays When Member Has Other Primary Insurance (PDF) January 1, 2004
CM-024: Peer Support and Peer Support Waiver Exceptions (PDF) July 2, 2014
Attachment
- CM-024-01: Attachment 1: Peer Support Authorization Request (PDF)
CM-028: Authorization Requests for Preauthorized Drug and Alcohol Services (PDF) February 14, 2012
CM-029: Authorization Requests for Drug and Alcohol Hospital and Non-Hospital-Based Detoxifications (PDF) April 11, 2012
CM-034: Emergency Services Coverage Reimbursement (PDF) July 24, 2003
CM-036: Mental Health/Substance Abuse Targeted Case Management Initial and Reauthorization Requests and Discharges (PDF) May 20, 2008
CM-037: Mental Health/Substance Abuse Targeted Case Management Reimbursable and Non-Reimbursable Services (PDF) August 15, 2018
CM-039: Targeted Case Management Contact Expectations (PDF) June 9, 2008
CM-040: Targeted Case Management Role Expectations (PDF) July 1, 2008
CM-042: Continued Stay Review Process (PDF) July 1, 2014
CM-043: Authorization Requests for Preauthorized Mental Health Services (PDF) February 14, 2012
CM-045: Prior Authorization Requests for Electroconvulsive Therapy (ECT) (PDF) April 10, 2012
CM-046: Psychiatric Rehabilitation (PDF) December 1, 2016
Attachment
- CM-046-01: Attachment 1: Psychiatric Rehabilitation Form (PDF)
CM-047: Authorization and Delivery of Music Therapy Services (PDF) November 13, 2017
Attachments
- CM-047-01: Attachment 1: Music Therapy Request Form (PDF)
CM-CAS-010: Interagency Services Planning Teams — Community Rehabilitation Host Home (CRR-HH) and Residential Treatment Facility (RTF) (PDF) October 1, 2005
CM-CAS-029: Completion and Submission of Best Practice Evaluations and Continued Care Evaluations (PDF) September 13, 2018
CM-CAS-044: Procedure to Request Additional Service Units During an Authorization Period and Extension Requests for Family-Based Mental Health Services (FBMHS) (PDF) February 4, 2019
CM-CAS-047: Pre-Discharge Planning Meeting Requirements for Residential Treatment Facility (RTF) (PDF) October 23, 2018
CM-CAS-048: Pre-Discharge Planning Meeting Requirements for Community Residential Rehabilitation (PDF) October 23, 2018
CM-CAS-050: Community Rehabilitation Host Home (CRR-HH) November 15, 2017 (PDF) November 15, 2017
CM-CAS-051: Procedure for Prior Authorization and Extension Requests for Family-Based Mental Health Services (FBMHS) (PDF) November 15, 2017
Attachments
- CM-CAS-051-01: Attachment 1: FBMHS Referral Form (PDF) November 15, 2017
- CM-CAS-051-02: Attachment 2: FBMHS Treatment Review Update Form (PDF) November 15, 2017
- CM-CAS-051-03: Attachment 3: FBMHS Interagency Service Planning Team Meeting Form (PDF) November 15, 2017
- CM-CAS-051-04: Attachment 4: FBMHS Prescription Letter (PDF) November 15, 2017
CM-MS-003: Outpatient Treatment Requests, Denials, and Authorizations (PDF) October 16, 2003
CC-CG-002: Provider Complaint Process (PDF) June 11, 2015
PR-001: Service Authorization Procedures and Standards for Out-of-Network Providers (PDF) December 21, 2008
PR-005: Payment Authorization Procedures (PDF) October 19, 2017
PR-014: Assessment of Provider Cultural Sensitivity (PDF) February 22, 2018
Attachments
- PR-014-01: Attachment 1: PerformCare Initial and Recredentialing Site Visit Form (PDF) February 22, 2018
- PR-014-02: Attachment 2: PerformCare Part II Credentialing Site Visit Form (PDF) February 22, 2018
- PR-014-03: Attachment 3: PerformCare Provider Self Site Review Form (PDF) February 22, 2018
PR-015: Distribution of Medical Necessity Criteria to PerformCare Providers (PDF) February 22, 2018
PR-016: DHS Notification of Drop in Provider Capacity (PDF) March 28, 2018
PR-019: Processing Provider MA Enrollment Applications (Supplemental Services and Out of Network) (PDF) April 30, 2018
PR-020: Routine and Non-Routine Site Visits (PDF) April 30, 2018
PR-023: Advance Directives (PDF) May 8, 2018
PR-025: PerformCare Position on the Bundling of Psychiatric Services (PDF) May 8, 2018
PR-026: Provider Rate Setting (PDF) May 14, 2018
Attachments
- PR-026-01: Attachment 1: PerformCare Rate Request Form (PDF) May 14, 2018
- PR-026-02: Attachment 2: RTF Criteria and Rate-Setting Tools (PDF) May 14, 2018
PR-027: Interpreter Costs in Service Delivery (PDF) May 8, 2018
PR-028: Requirements for School-Based Outpatient Services (PDF) May 7, 2018
PR-029: Expansion Request Process for State Plan Service for Providers (PDF) May 23, 2018
PR-032: Provision of Reasonable Access to BHS Provided by FQHC Within Access Travel Guidelines (PDF) May 23, 2018
QI-006: Monitoring Plan for Service Transitions (PDF) October 24, 2018
QI-014: Member and Provider Satisfaction Surveys (PDF) October 24, 2018
QI-019: Provider Profiling Reports (PDF) August 7, 2018
QI-026: Provider Treatment/Service Record Reviews (PDF) August 10, 2018
QI-040: Evaluator Monitoring (PDF) October 1, 2015
QI-042: Six-Criteria Complaint Policy (PDF) August 22, 2018
Attachment
- QI-042-01: Attachment 1: General Requirements for Complaint, Grievance, and Fair Hearing Processes (PDF) August 22, 2018
QI-043: Dissatisfaction Complaint Policy (PDF) August 22, 2018
Attachment
- QI-043-01: Attachment 1: General Requirements for Complaint, Grievance, and Fair Hearing Processes (PDF) August 22, 2018
QI-044: Grievance Policy (PDF) August 22, 2018
Attachment
- QI-044-01: Attachment 1: General Requirements for Complaint, Grievance, and Fair Hearing Processes (PDF) August 22, 2018
QI-CIR-001: Critical Incident Reporting (PDF) February 2, 2018
Attachments
- QI-CIR-001-01: Attachment 1: Critical Incident Report Form (PDF) February 2, 2018
- QI-CIR-001-02: Attachment 2: Provider-Preventable Conditions (PDF) February 2, 2018
QI-CIR-002: Sentinel Event Review (PDF) January 22, 2018
QI-CIR-003: Restraint and Seclusion Monitoring (PDF) January 22, 2018
Attachment
- QI-CIR-003-01: Attachment 1: Report of Restraint or Seclusion Form (PDF) January 22, 2018
QI-CIR-001: Credentialing and Recredentialing Criteria — Facilities (PDF) August 10, 2017
Attachments
- QI-CR-001-01: Attachment 1: PerformCare Site Visit Tool (PDF) August 10, 2017
- QI-CR-001-02: Attachment 2: Recredentialing Provider Summary (PDF) August 10, 2017
- QI-CR-001-03: Attachment 3: Facility Credentialing and Recredentialing Application (PDF) August 10, 2017
QI-CR-002: Credentialing and Recredentialing Criteria — Practitioners (PDF) February 25, 2020
Attachments
- QI-CR-002-01: Attachment 1: PerformCare Site Visit Tool (PDF) December 21, 2018
- QI-CR-002-02: Attachment 2: Recredentialing Provider Summary (PDF) February 25, 2020
QI-CR-003: Credentialing Progressive Disciplinary Action for Providers (PDF) December 21, 2018
Attachments
- QI-CR-003-01: Attachment 1: Referral to Credentialing Committee Form Template (PDF) December 21, 2018
- QI-CR-003-02: Attachment 2: Oversight Agreement Form Template (PDF) December 21, 2018
QI-CR-005: Credentialing Committee (PDF) November 28, 2018
Attachment
- QI-CR-005-01: Attachment 1: Credentialing Committee Confidentiality and Non-Discrimination Statements (PDF) November 28, 2018
QI-SIU-001: Development and Monitoring of Quality Improvement Plans (QIPs) Issued by the Special Investigation Unit (PDF) June 8, 2018
Attachments
- QI-SIU-001-01: Attachment 1: Special Investigation Unit QIPs Monitoring Log (PDF) June 8, 2018
- QI-SIU-001-02: Attachment 2: QIP Approval Letter Template (PDF) June 8, 2018
PerformCare provider notices
2021
- AD 21 102: Collecting Social Determinants of Health (SDOH) Data (PDF)
- AD 21 101: False Claims Certification (PDF)
- AD 21 100: Tobacco Cessation Resources (PDF)
2020
- CABHC Alternative Payment Arrangement (APA) Status (PDF)
- TMCA Alternative Payment Arrangement (APA) Status (PDF)
2019
- AD 19 104: Medicare Crossover Claims (PDF)
- AD 19 103: Using Your CLIA ID When Filing Claims (PDF)
- AD 19 102: Collecting Social Determinants of Health (SDoH) Data to Address Members’ Unmet Needs (PDF)
- AD 19 101: Transition of Bedford-Somerset HealthChoices Contract (PDF)
- AD 19 100: Service Location Enrollment Deadline (PDF)
2018
- AD 18 106: Tobacco Cessation Providers (PDF)
- AD 18 105: Capital Area Performance Incentive Payments (PDF)
- AD 18 104: Changes to Prior Authorization and Denial Process (PDF)
- AD 18 103: Do You Want to Save Time and Shorten Your Reimbursement Cycle? (PDF)
- AD 18 102: Discharge Planning: Using the Teach Back Method (PDF)
- AD 18 101: Discharge Management Plans (PDF)
- AD 18 100: Partner With Us to Prevent Health Care Fraud Waste and Abuse (PDF)
2017
- AD 17 104: Ordering, Rendering, and Prescribing Providers (PDF) Updated – March 1, 2019
2016
- AD 16 106: Information System Update and Timeline (PDF)
- AD 16 104: Franklin, Fulton Retroactive Performance Incentive Payments (PDF)
- AD 16 103: Information System Transition (PDF)
- AD 16 101: Utilization Management Process (PDF)
- AD 16 100: Bedford, Somerset retroactive performance incentive payments (PDF)
2015
- AD 15 100: Process Change for OP Requests Requiring MNC or Registration (PDF)
- AD 15 101: Behavioral Health Screening Programs (PDF)
- AD 15 102: Treatment Record Review and Risk Assessment (PDF)
- AD 15 106: Enhanced Care Management (ECM) Program (PDF)
- PC-13: Collaborative Documentation (PDF)
- 45-PC 02-14-01: Compensation & Progress Notes (PDF)
Providers of Peer Support Services should review the policy clarification 45-PC 02-14-01 which was released by the Office of Mental Health and Substance Abuse Services Bureau of Policy, Planning and Program Development on April 16, 2014. This policy clarification contains important information about billing and time spent completing progress notes.
- 45-PC 02-14-01: Compensation & Progress Notes (PDF)
- AD 15 108: Quality Improvement Resources Available on PerformCare Website (PDF)
2002 - 2014
- AD 14 105 OMHSAS 14-03: Bulletin ACA Re-enrollment Requirement (PDF)
- AD 14 105 Att 1: OMHSAS Bulletin On MA Enrollment (PDF)
- AD 14 105 Att 2: OMAP Bulletin Re-enrollment 99-14-06 (PDF)
- AD 14 107: PerformCare Harrisburg Mailing Address Change (PDF)
- AD 13 103R: NCCI Claims Edits (PDF)
- PC-02: Mobile Crisis Intervention (PDF)
- PC-03: Mental Health Targeted Case Management (TCM) Transportation Clarification (PDF)
- PC-04: TCM Concurrent Billing With PH-BH Appointments (PDF)
- PC-06: Electronic Signatures (PDF)
- AD 12 100: Common Problem Areas and Provider Performance Reports (PDF)
- AD 12 112: 2013 CPT Code Update Implementation (PDF)
- AD 11 109: Clarification of Payment Policy (PDF)
Day of admission and day of discharge for inpatient services - AD 11 115: MA Bulletin 99-11-05 (PDF)
"Provider Screening of Employees and Contractors for Exclusion from Participation in Federal Health Care Programs and the Effect of Exclusion on Participation" - AD 10 002: Coordination With Crisis Intervention Services (Capital Area) (PDF)
- AD 10 006: Billable Reportable Time (PDF)
- AD 10 110: Compliance and Billing Reminders (PDF)
MH partial hospitalization, MH outpatient, CRR, BHRS, FBMHS and concurrent services - AD 09 109: Provider Corporate Compliance Initiatives and OMAP Bulletin 99-02-13 (PDF)
- AD 09 111: Additional Fraud and Abuse Requirements (PDF)
per Section 6034 of the Deficit Reduction Act - AD 04 003: Notification Requirements for PerformCare as Secondary Payer (PDF)
- AD 02 012: EVS and Authorization Requirements (PDF)
- AD 03 001: Naming Conventions for Provider Communications (PDF)
2017
- AD 17 107: New NaviNet Electronic Claim Inquiry Enhancement (PDF)
- AD 17 106: Clarification of Rejected and Corrected Claim Rules (PDF)
- AD 17 105: NaviNet Authorization and Claims Reports for Providers (PDF)
- AD 17 101: Timely Filing of Claims Requirements for all Behavioral Health Services of Somerset and Bedford Counties (PDF)
- AD 17 101: Timely Filing of Claims Requirements for all Capital Area Behavioral Health Collaborative (PDF)
- AD 17 101: Timely Filing of Claims Requirements for all Tuscarora Managed Care Alliance (PDF)
2016
- AD 16 102: Additional Pre-payment Claims Edits for Duplicate/Disallowed Services (PDF)
- PC-18 FQHC/RHC Prospective Payment System (PDF)
2015
- AD 15 107: HIPAA 5010 X12 Format Requirements (PDF)
- AD 15 104: Remittance Advice Update (PDF)
- PC-17: Pharmacogenomics Tests for Psychiatric Medications (PDF)
2014
- AD 14 101: New 1500 Claim form Corrected Claims March 2014 (PDF)
2013
- AD 12 110R: Electronic Submission of Corrected Claims (PDF)
- AD 13 103R: NCCI Claims Edits (PDF)
- PC-14: Provider Memo TCM Billing for Records Review (PDF)
2011
- AD 11 104: Claims Submission and POS 03 for Services Provided In Schools Reminder (PDF)
- AD 11 107: NPI (National Provider Identifier) and Claims Submission Reminder (PDF)
- AD 11 108: Claims Submission and POS 50 In Federally Qualified Health Centers (FQHC) (PDF)
- AD 11 111: Change In Mailing Address and Handling of Paper Claims (PDF)
- AD 11 114: EMDEON Payer ID for Electronic Claims (PDF)
- AD 11 113: Transition to EMDEON for ERA and EFT (PDF)
2010
- AD 10 109: Claims Submission and POS 03 for Services Provided in Schools (PDF)
2009
- AD 09 102: Faxed Claims No Longer Accepted (PDF)
2017
- MH 17 100: Improving Family Based Mental Health Services 7-Day Routine Access (PDF)
2014
- PC-15: Billing for FBMH No Shows (PDF)
2012
- FBMH 12 100: Family-Based Mental Health Services Update (PDF)
2008
- FBMH 08 000: Clarification of Family-Based Mental Health Services Billing for Travel Time (PDF)
2004
- FBMH 04 002: FBMHS Coordination and Reporting (PDF)
2017
2014
- AD 14 100: Verification of Psychiatric and Substance Abuse Inpatient Rehab Hospital Admission (PDF)
- AD 14 102: Change In Initial Assessment Continued Stay and Discharge (PDF)
- AD 14 102A: UM MH (PDF)
- AD 14 102B: UM SA (PDF)
- AD 14 102C: MSS Bedsearch (PDF)
- AD 14 104: Change In UM Contact Process (PDF)
2013
- PC-11: CRNP for Inpatient Hospital Care v.3 (PDF)
2011
- AD 11 101: Federal Regulations 42, CFR Subpart D Related to JCAHO Accreditation (PDF)
Final ruling
2010
- MH 10 106: MH IP Discharge Planning and Member Letter (PDF)
2009
2008
- MH 08 000: Psychiatric Inpatient Admissions for Member on a Medical Floor (PDF)
2003
- AD 03 003: Blood Alcohol Levels and Level of Care Determinations (PDF)
2021
- IBHS 21 102: IBHS Billable Activity (PDF)
- IBHS 21 101: IBHS Assessment Requirements (PDF)
- IBHS 21 100: IBHS ABA Billing Guide (PDF)
2020
- IBHS 20 105: Clarification of Written Order Prescriptions for IBHS-ABA Services (PDF)
- IBHS 20 104: BHRS Transition (PDF)
- OMHSAS-20-04: Payment for IBHS Prior to Licensure May 12, 2020 (PDF)
- IBHS 20 104: PerformCare Intensive Behavioral Health Services (IBHS) Attestation Form (PDF)
- OMHSAS-20-04: Payment for IBHS Prior to Licensure Attachment — Final May 21, 2020 (PDF)
- IBHS 20 103 Update: Provider Notice Children's Level of Care and Prescriptions (PDF)
- IBHS 20 102 Update: Dual Prescription Recommendation (PDF)
- IBHS 20 101 Update: IBHS 20 101 CABHC IBHS Rate Notice (PDF)
- IBHS 20 101 Update: IBHS 20 101 TMCA IBHS Rate Notice (PDF)
- IBHS 20 100 Update: All IBHS/BHRS/Other Children’s Level of Care and Evaluators (PDF)
2021
- MH 21 101: Capital Area Performance Payments (PDF)
- MH 21 100: Pennsylvania Act 65 of 2020 (PDF)
2020
- MH 20 101: Capital Area Performance Payments 2020 (PDF)
- MH 20 102: RTF Packet Attachment 8 (PDF)
- MH 20 104: Change in Partial Hospitalization Unit Definition (PDF)
- MH 20 100: RTF Bed Hold Update (PDF)
2018
- MH 18 100: Partial Hospitalization Continued Stay and Discharge Process (PDF)
2017
- MH 17 101: Eliminating the Distinction of Acute vs. Non-Acute Partial Hospitalization (PDF)
- PC-19: Medicaid Enrollment of Ordering, Referring, and Prescribing Providers (PDF)
2016
- MH 16 101: Trauma-Focused Cognitive Behavior Therapy (TF-CBT) Modifier (PDF)
- MH 16 100: New CPT Code 96127 Brief Emotional-Behavioral Assessment (PDF)
2015
- AD 15 100: Process Change for OP Requests Requiring MNC or Registration (PDF)
2002 - 2014
- MH 14 100: Assertive Community Treatment Code Changes (PDF)
- MH 14 100A: Assertive Community Treatment ACT Authorization form (PDF)
- AD 14 103: Outpatient Codes for Initial Services BS Level in Standard (PDF)
- PC-07: MH-OP Treatment Plan No Show v.2 (PDF)
- PC-09: OP Treatment Plan Frequency v.2 (PDF)
- PC-12: Physician Services In MH OP Clinics (PDF)
- MH 11 100: Utilization of FBAs In a Partial Hospital Program (PDF)
- MH 10 102: Addition of Interactive Telecommunications Modifier for Peer Support (PDF)
per revised bulletin OMHSAS-09-07 - MH 10 105: Psychiatric Rehabilitation Coding Changes (PDF)
- MH 03 005: Medication Management and Psychotherapy as Stand-Alone Services (PDF)
- AD 02 011: Medication Management and Partial Hospital Requirements (PDF)
2021
- SU 21 100: Medication Assisted Treatment in SU Programs (PDF)
- SA 21 101: ASAM Alignment and MAT Webinar (PDF)
2020
- SU 20 101: ASAM Alignment 3.5 Short-term vs. Long-term Non-Hospital Rehab (PDF)
- SU 20 102: Change in Statutory Treatment Limits (PDF)
- SUD 20 103: Opioid Treatment Programs Billing Medicare (PDF)
2018
- SA 18 101: Inpatient Withdrawal Management Notification of Admission (PDF)
- SA 18 100: DDAP Transition to American Society of Addiction Medicine (ASAM) for Substance Use Disorder Levels of Care (PDF)
2016
- SA 16 100: SA IOP Registration/Prior Authorization Requirement (PDF)
- SA IOP Request Form (PDF)
2014
- AD 14 100: Verification of Psychiatric and Substance Abuse Inpatient Rehab Hospital Admission (PDF)
- AD 14 102: Change In Initial Assessment Continued Stay and Discharge (PDF)
- AD 14 102A: UM MH (PDF)
- AD 14 102B: UM SA (PDF)
- AD 14 102C: MSS Bedsearch (PDF)
- AD 14 104: Change In UM Contact Process (PDF)
- PC-16: Lab Changes During Substance Abuse Treatment (PDF)
2013
2012
- SA 12 100: Substance Abuse Intensive Outpatient Program Expectations (PDF)
Cumberland, Dauphin, Lancaster, Lebanon and Perry Counties - SA OP 12 103: Compliance Reminders (PDF)
Documentation and delivery substance abuse outpatient, methadone and suboxone services
2009
- SA 09 100: Methadone Billing for Take Home Services (PDF)
DHS notices, bulletins and clarifications
- OMHSAS-20-04: Payment for IBHS Prior to Licensure May 12, 2020 (PDF)
- OMHSAS-20-04: Payment for IBHS Prior to Licensure Attachment — Final May 21, 2020 (PDF)
- OMHSAS-20-02: Guidelines for the Use of Telehealth in the Delivery of Behavioral Health Services (PDF) February 20, 2020
- 20-20-02 Attachment B: Attestation Form (PDF)
- OMHSAS-19-05: Peer Support Services — Revised (PDF) December 10, 2019
- 99-89-05: DPW Bulletin Signature Requirements and Encounter Forms (PDF) November 7, 2019
- 99-89-05 Attachment 01: Encounter Form (PDF)
- Service location enrollment for behavioral health providers (PDF) October 1, 2019
- Provider enrollment application consolidation (PDF) July 1, 2019
- Applied Behavior Analysis (PDF) May 16, 2019
- OMAP 99-17-02: Submission of Claims that Require the National Provider Identifier (NPI) of a Medical Assistance Enrolled Ordering, Referring or Prescribing Provider (PDF) January 30, 2017
- OMHSAS-16-12: Peer Support Services - Revised (PDF) December 12, 2016
- OMAP 99-16-15: Payment of Claims for Autism Spectrum Disorder (ASD) (PDF) August 17, 2016
- OMHSAS Policy Clarification 03-16-01: Encounter Coding (PDF) March 21, 2016
- OMHSAS-16-09: Medical Necessity Guidelines for ABA (PDF) July 1, 2016
- Description of Service (PDF)
- OMHSAS-16-07: Enrollment and Payment of Provider Entities, Applied Behavior Analysis (PDF) June 6, 2016
- OMAP 99-16-04: Enrollment of Co-Located Providers (PDF) May 31, 2016
- OMHSAS-16-06: Payment for Room and Board when Services are Provided by a CARF or COA Accredited Residential Treatment Facility (PDF) May 16, 2016
- OMHSAS-16-04: Training Requirements for Licensed Behavior Specialists Who Use Behavioral Specialist Consultant-Autism Spectrum Disorder Services to Provide Applied Analysis (PDF) April 26, 2016
- OMHSAS-16-03: Revised Procedure for Waiver of Office of Mental Health and Substance Abuse Services Program Regulations and Standards (PDF) April 19, 2016
- Pennsylvania Opioid Use Disorder Centers of Excellence Cover letter (PDF)
- OMAP PowerPoint on Health IT Initiative Update on Behavioral Health Opportunities (PDF) April 1, 2016
- DHS FQHC / RHC Prospective Payment System (PPS) FAQ (PDF)
- OMHSAS 16-01: Mental Health Emergency Services Guidelines (PDF) January 8, 2016
- OMHSAS-16-02: Training and Supervision Requirements for Therapeutic Staff Support (TSS) Workers that Implement Treatment Plans that Include Applied Behavioral Analysis (PDF) March 11, 2016
- TSS Training (PDF)
- OMHSAS Applied Behavioral Analysis Attestation (ABA) Memo (PDF) March 10, 2016
- ABA Attestation (.docx)
- ABA Behavioral Specialist Consultant Confirmation (.docx)
- DHS 01-15-28 Provider Preventable Conditions (PDF) September 1, 2015
- DHS Mandatory Reporting Requirements covered by Adult Protective Services Act (PDF) April 8, 2015
- DPW Adult Protective Services (APS) Letter (PDF) May 26, 2015
- OMHSAS Medical Assistance (MA) Coverage of Services to Children With Autism Spectrum Disorder (ASD) (PDF) March 18, 2015
- OMAP 99-14-09: Implementation of Healthy PA (PDF) November 4, 2014
- OMHSAS 14-04: DSM Fifth Edition (PDF) September 5, 2014
- OMHSAS 14-03: Affordable Care Act (ACA) Provider Re-Enrollment for Behavioral Health Providers (PDF) August 1, 2014
- OMHSAS 14-02: Payment of Licensed Providers for Children with ASD (PDF) May 23, 2014
- OMHSAS DPW Policy Clarification 01-14-01: MA Payment for Diagnostic Laboratory Services (PDF) April 30, 2014
- OMHSAS 14-01: Guidelines for Telepsych Services Approval (PDF) March 18, 2014
- OMHSAS Policy Clarification 03-14-02: BHMCO Attestation Form (PDF) March 10, 2014
- OMAP 99-14-01: Re-enrollment/Revalidation of Medical Assistance (MA) Providers (PDF) March 7, 2014
- OMHSAS Policy Clarification 03-14-01: Psych Rehab Codes (PDF) March 6, 2014
- OMHSAS Policy Clarification 02-14-01: Compensation Progress Notes (PDF) February 25, 2014
- OMHSAS Policy Clarification 01-14-01: Group Services in Partial Hospitalization Programs (PHPs) (PDF) January 15, 2014
- OMHSAS Policy Clarification 01-14-01: Diagnostic Lab Payment in D&A Clinics (PDF) January 15, 2014
- OMHSAS Policy Clarification 10-13-01: Recovery of Overpayments (PDF) October 31, 2013
- OMHSAS Policy Clarification 09-13-01: Peer Support Applicability (PDF) September 18, 2013
- OMHSAS Policy Clarification 09-13-01: HealthChoices Capitation Payments (PDF) September 18, 2013
- OMHSAS Policy Clarification 09-13-01: Financial Reporting (PDF) September 13, 2013
- OMHSAS Policy Clarification 08-13-01: Assertive Community Treatment (ACT) Substance Abuse Specialist (PDF) August 10, 2013
- OMHSAS Policy Clarification 06-13-01: Nurse Billing E&M Code (PDF) June 17, 2013
- OMHSAS Policy Clarification 03-13: TSS Simultaneously with OT, ST, or PT in School (PDF) March 27, 2013
- OMHSAS Policy Clarification 02-13: Pharmacologic Management (PDF) February 14, 2013
- OMHSAS 13-01: Targeted Case Management (TCM) Travel Transportation Guidelines (PDF) January 18, 2013
- OMHSAS Policy Clarification 01-13: Prior Authorization Code Clarification for Group Psychotherapy (PDF) January 8, 2013
- OMAP 99-12-12: Updates to National Correct Coding Initiative (NCCI) (PDF) October 26, 2012
- OMHSAS Policy Clarification 06-12: Pharmacologic Management (PDF) October 9, 2012
- OMHSAS Policy Clarification 04-12: Crisis Residential Services (PDF) August 9, 2012
- OMHSAS Policy Clarification 02-12: Retroactive Provider Rate Adjustment Policy (PDF) March 18, 2012
- OMAP 99-12-03: Updates to Medical Assistance Co-payment Policy (PDF) April 16, 2012
- OMAP 99-12-01: PES Software (PDF) April 6, 2012
- OMHSAS-12-01: Summer Therapeutic Activities Program (STAP) (PDF) March 1, 2012
- OMHSAS Policy Clarification 01-12: Transportation for Psych Rehab Services (PDF) January 24, 2012
- OMHSAS Mental Health Case Manager Refresher Training (PDF) January 13, 2012
- OMHSAS 11-09: Telepsychiatry Guidelines (PDF) December 12, 2011
- OMHSAS Policy Clarification 03-11: Alternative Payment Arrangements (PDF) November 18, 2011
- OMAP 99-11-10: National Correct Coding Initiative (NCCI) Announcement (PDF) November 10, 2011
- OMAP 99-11-05: Provider Screening of Employees (PDF) August 15, 2011
- OMHSAS Use of Safe Physical Management and Time Outs (PDF) July 6, 2011
- OMHSAS Policy Clarification 01-11: Psych Diagnostic Coding (PDF) May 6, 2011
- OMHSAS 11-05: Permissible Arrangements for BHRS Psychologists (PDF) March 8, 2011
- OMHSAS 11-01: Non-Discrimination Toward LGBTQI (PDF) January 7, 2011
- DPW 00-10-02: Complex Case Planning (PDF) December 28, 2010
- OMHSAS 10-04: Psych/Clinical Re-Evaluation for BHRS (PDF) July 9, 2010
- OMHSAS 10-04: FAQ 6 Month Evaluations/Authorization (PDF)
- OMHSAS 10-03: Blended Case Management (BCM) Revised (PDF) June 14, 2010
- OMHSAS 10-03: Definitions Attachment A (PDF)
- OMHSAS 10-03: Services for severely emotional disturbance disorders Appendix A (PDF)
- OMHSAS 10-03: Community Support Values and Principles Appendix B (PDF)
- OMHSAS 10-03: Fiscal Issues Attachment B (PDF)
- OMHSAS 10-03: Provider Enrollment Attachment C (PDF)
- OMHSAS 10-03: Recovery Principles Appendix C (PDF)
- OMHSAS 10-03: Blended Case Mgmt Guidelines Attachment D (PDF)
- OMHSAS Policy Clarification 02-11: Educational requirements for Behavioral Specialist Consultant (BSC) (PDF) June 9, 2010
- OMHSAS 10-01: Medication Prescribing Practices of CRNP's in MH and Mental Retardation Programs (PDF) March 27, 2010
- OMHSAS Policy Clarification 01-10: Payment for Room & Board in Non-Hospital D&A Facilities (PDF) February 25, 2010
- OMHSAS 10-01: Educational Portions of "Non-Educational" Residential Placement (PDF) January 4, 2010
- OMHSAS 09-07: Peer Support Services Revised (PDF) January 1, 2010
- DPW 3800-09-02: Prone Restraints in Children's Facilities (PDF) December 19, 2009
- DPW 3800-09-01: Strategies and Practices to Eliminate Unnecessary Restraints (PDF) December 19, 2009
- OMHSAS Policy Clarification 07-09: Payment for Drug and Alcohol Outpatient Services (PDF) October 13, 2009
- OMHSAS 09-05: Peer Support Revised (PDF) September 22, 2009
- OMHSAS Policy Clarification 06-09: Fraud and Abuse Requirements (PDF) September 8, 2009
- OMHSAS Personal Care Home Policy (PDF) August 18, 2009
- OMHSAS functional behavioral assessment (FBA) Q&A (PDF) June 16, 2009
- OMHSAS Policy Clarification 04-09: Psych Evaluations for STAP (PDF) February 18, 2009
- OMHSAS Policy Clarification 03-09: Payment for Federally Qualified Health Clinics (FQHC) and Rural Health Clinics (RHC) (PDF) February 11, 2009
- OMHSAS Policy Clarification 05-09: Crisis Intervention vs Emergency Services (PDF) February 10, 2009
- OMHSAS 09-04: Family Involvement with Youth in RTF (PDF) June 15, 2009
- OMHSAS 09-01: Guidance for Conducting Functional Behavioral Assessments (FBA) (PDF) January 9, 2009
- OMHSAS Policy Clarification 02-09: Mobile Mental Health Tx exempt from TPL (PDF) October 29, 2008
- OMHSAS Policy Clarification 08-09: Timeframe for Psych Evals for RTF Admission (PDF) October 20, 2008
- OMHSAS Policy Clarification 02-08: Email Communication (PDF) October 1, 2008
- OMHSAS 08-03: Assertive Community Treatment (ACT) (PDF) September 2, 2008
- OMHSAS Policy Clarification 2008-002: List of Six Claim Adjustment Reason (CAR) Codes (PDF) June 20, 2008
- OMHSAS Policy Clarification 03-08: Scope of Practice for CRNPs (PDF) May 8, 2008
- OMHSAS Policy Clarification 02-07 : Adverse Incident Reporting (PDF) October 5, 2007
- OMHSAS Policy Clarification 01-07: Partial Hospitalization Program (PHP) Services (PDF) September 13, 2007
- OMAP 99-07-13: Updated: Regarding False Claims Provisions of Deficit Reduction Act of 2005 (PDF) September 7, 2007
- DPW 08-07-09: Peer Support Services (PDF) May 22, 2007
- DPW Peer Support Services Supplemental Provider Agreement (PDF)
- DPW Peer Support Service Description Checklist (PDF)
- CMS FAQ for Peer Support Services in PA (PDF) May 1, 2007
- OMAP 99-07-01: Employee Education about False Claims Recovery (PDF) January 2, 2007 - Employee education about false claims recovery
- DPW 08-06-18: Mobile Mental Health Treatment (PDF) November 30, 2006
- MA Mobile Mental Health Treatment Handbook (PDF) November 1, 2006
- MA Fee Schedule (PDF)
- MA Handbook for Other Services (PDF) November 1, 2006
- DPW 09-05-16: Clarification of Enrollment Policy for CRNPs (PDF) December 16, 2005
- DPW TSS Transportation (PDF) July 7, 2005
- OMHSAS Policy Clarification 03-05: Qualifications for Behavioral Specialist Consultant (BSC) & Ph.D. (PDF) May 13, 2005
- DPW 28-04-01: Methadone Take-Home Services (PDF) February 1, 2004
- OMHSAS Policy Clarification 07-03: Licensed Group Homes (PDF) August 5, 2003
- OMHSAS Policy Clarification 18-02: Scope of Practice for Physician Assistants (PDF) December 20, 2002
- DPW 99-02-13: The Bureau of Program Integrity and the Medical Assistance Provider Self-Audit Protocol (PDF) December 2, 2002
- DPW 01-02-11: RTF Services Provided in a Secure Setting (PDF) October 1, 2002
- OMHSAS 02-01: The Use of Seclusion and Restraint in MH Facilities and Programs (PDF) April 8, 2002
- DPW 01-02-07: Reminder for BHRS Documentation Requirements (PDF) April 3, 2002
- OMHSAS Policy Clarification 16-02: TPL Issues (PDF) March 30, 2002
- DPW 29-02-03: Medical Record Keeping Requirements (PDF) March 21, 2002
- OMHSAS Policy Clarification 02-02: Parent availability for TSS services (PDF) January 14, 2002
- OMHSAS Q&A 11-97-176: Responsibility for Pharmaceuticals for an Inpatient BH Admission (PDF) September 2001
- DPW 01-01-07: Addition of BHRS to the Medical Assistance (MA) Program Fee Schedule (PDF) June 21, 2001
- OMHSAS Q&A 3-96-198: Non-Participating Providers allowed to Balance Bill (PDF) June 19, 2000
- OMHSAS Q&A 3-96-199: Definable Compensable Services (PDF) June 19, 2000
- OMHSAS Q&A 3-96-195: Bypass Primary Payer (PDF) May 8, 2000
- OMHSAS Q&A 11-97-66: Network Contracting (PDF) July 7, 1999
- DPW 28-99-02: Medication Management Visit (PDF) April 26, 1999
- DPW Policy Clarification RH-01: Age Limit for BHRS (PDF) March 4, 1999
- DPW 01-98-19: Clozapine Support Services (PDF) December 29, 1998
- DPW Inappropriate Delivery and Billing for TSS Services (PDF) January 6, 1998
- DPW 99-97-06: Accurate Billing for Units of Service Based on Periods of Time (PDF) September 17, 1997
- DPW 01-97-08: Diagnostic and Psychological Evaluations (PDF) May 28, 1997
- DPW 01-96-11: Procedures for Service Descriptions (PDF) April 29, 1996
- DPW 50-96-03: Summer Therapeutic Activities Program (PDF) April 25, 1996
- DPW 01-95-13: Updated JCAHO Accredited RTF Services (PDF) September 8, 1995
- DPW 01-95-01: Signature Requirements (PDF) January 2, 1995
- DPW 01-94-01: Outpatient Psychiatric Services for Children Under 21 Years of Age (PDF) January 11, 1994