Payer List

Please follow the Enrollment Instructions below to become an electronic submitter for Pennsylvania Medicaid.

To apply for a submitter ID and password for OMAP please go to:

http://www.dpw.state.pa.us/provider/promise/certification/certificationi...

• Scroll Down to the very bottom and click on the link that says: “PROMISe Transaction Certification Registration Form”.

If you have any questions regarding any of the documents in this package, please Call the OMAP EDI Technology Support Center at 1-800-248-2152.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Our Vendor Information

Registration Form

Section 1

• Select your Organization Type

Your claims will “NOT” be submitted through a Billing Service or Clearinghouse

Section 2

• Enter your TAX ID, UPIN, and PA Medicaid Provider Numbers
• Complete your Business information (Name, Address, etc…)
• Enter the name of the main contact person for your office and his/her contact info

Section 3

• Please select “Yes” on one of the following
  • 837/835 Institutional – for UB04 billings
  • 837/835 Professional – for CMS 1500 billings

Section 4

• For Software Information – Primary, select “Vendor Software”
• Enter our Vendor information provided on page 2 of this document.
• For Contact First and Last Name you may enter “Gigi Maniago”
• You may skip the box below for the NCPDP Terminal ID
• Skip the Software – Secondary Section
• Please skip the section for “Software Vendors Only”

Section 5

• Select the method you would like OMAP to use when sending you your certification information.
• For the medium for test and production select “Interactive or BBS”
• To receive results please also select “Interactive or BBS”
• Press Submit

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt.

After processing, a confirmation will be sent to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center toll-free at 1-800-248-2152.

Testing

Once you have received your Submitter ID and Password from OMAP, please call the SolAce Support Team and set an appointment for a Mailbox setup and Test Transmission to OMAP.

Please have 5 test claims ready for testing. (No More, No Less). Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.