PA Medicaid Behavioral Health Claims: PROMISe or BH-MCO?

Last updated: October 9, 2026.

Identify the payer before preparing the claim

For Behavioral HealthChoices services, work from the responsible BH-MCO’s rules. DHS’s telehealth bulletin explicitly directs HealthChoices providers to follow BH-MCO billing instructions. Our recommendation is to settle that route before selecting an electronic payer or claim workflow.

OMHSAS-22-02: behavioral health telehealth, July 2022

Use PROMISe for the applicable state claim workflow

PROMISe supports online claim submission and status inquiries. Its availability does not mean every Medicaid behavioral health claim belongs in state FFS. Use the DHS billing FAQ to check the state claim requirements when the service is payable through that route.

DHS Medicaid billing and claims status FAQ

Check state FFS status and filing limits

For state claims, DHS describes Provider Claim Inquiry searches by ICN, recipient, date range, or status within your authorized provider and location records. Its general FFS rule requires receipt of an original claim within 180 days of service and a rejected original claim resubmission within 365 days. Check exceptions and service-specific rules; these are not BH-MCO deadlines.

DHS billing and claims FAQ

Match billing and rendering providers

DHS distinguishes the group receiving payment from the individual who performed the service. The group may not bill as the rendering provider. Our suggested preparation check compares the clinician, group, location, service date, and enrollment relationship before submission.

DHS provider enrollment FAQs: individual and group practices

DHS: enroll as a Medicaid provider

Use the responsible BH-MCO’s claim resources

For Philadelphia’s CBH network, the provider manual landing page links professional and institutional companion guides, claim forms, and adjustment resources. Start at that maintained page rather than a bookmarked older PDF. These are CBH resources, not statewide instructions for every BH-MCO.

Community Behavioral Health provider manual and claim resources

Confirm the plan’s electronic submission route

Carelon Pennsylvania’s online-services chapter describes electronic professional and institutional claims and ProviderConnect access. Check the current instructions for the relevant plan and transaction. Our recommendation is to verify the clearinghouse destination and enrollment before sending a production claim.

Carelon Pennsylvania provider manual: going online

Track acknowledgments, denials, and corrections separately

Use DHS’s billing and claims status FAQ for state questions and the BH-MCO’s manual for its claims. Our recommended follow-up log keeps the claim reference, submission response, denial reason, and next action together. Confirm correction or appeal instructions and the applicable filing limit before resubmitting.

DHS Medicaid billing and claims status FAQ

Related Pennsylvania Medicaid guides

• PROMISe Provider Portal Login and Account Setup in PA

• PA Medicaid Enrollment for Therapists: PROMISe and ePEAP

• PA HealthChoices: Physical vs Behavioral Health MCOs by County

• Verify PA Medicaid Eligibility with PROMISe EVS

• PA Medicaid Mental Health Telehealth Billing: Current Rules

• Add your biller as a PROMISe alternate

• Check a PROMISe application using the ATN

• Assign an individual clinician’s fees to a group

Frequently Asked Questions

Should all MA mental health claims go through PROMISe FFS?

No. Identify the responsible delivery system and follow the BH-MCO’s instructions for HealthChoices services.

Can a group be the rendering provider?

DHS says the individual performing the service is the rendering provider; the group identifies the payment entity.

Is there one statewide BH-MCO filing deadline?

Use the responsible BH-MCO’s current manual and contract. Do not copy an FFS deadline into a managed care workflow.