PA Department of Public Welfare



 
 

Provider Electronic Solutions Software

Pennsylvania Medical Assistance (MA) has made the Provider Electronic Solutions software available free-of-charge to the Pennsylvania provider community. The software runs on Microsoft Windows operating systems on IBM compatible computers and will submit a HIPAA ready transaction to Pennsylvania MA. We are making this software available to those that want to submit claims or recipient eligibility inquiries to MA electronically but may not be purchasing a product from a software vendor or creating their own solution.

Software Description and System Requirements - this link provides basic information, including the system requirements, regarding the Provider Electronic Solutions software.

Provider Electronic Solutions Software User's Manual *

The newest version (V4.03) of the Provider Electronic Solutions software is now available. This V4.03 release is recommended for those providers using PES for 835 viewing. Download and use of V4.03 is Required for All Professional and Outpatient transactions. PES 4.03 implements the ACA-ORP; which adds the Referring and Ordering Provider to the detail line for Professional and adds the Referring Provider to the detail service line for the Outpatient. This also includes NCPDP Enhancements.

Note: Claim Adjustment Reason Codes (CARC)
Remittance Advice Remark Codes (RARC)

For complete CARC/RARC Descriptions, please visit the following web site:
Washington Publishing Company: http:www.wpc-edi.com
CAQH CORE website: http:wwww.caqh.org

Known Issue with this Release:

Version 4.02 includes:

  • ACA-ORP:
    • Add Referring Provider and Ordering Provider to the detail service line for Professional.
    • Add Referring Provider to the detail service line for Outpatient.
    • When NDC code is used on 837 Professional and 837 Outpatient, deactivate both the Referring and Ordering Providers for Professional and deactivate the Referring provider for 837 OutPatient. Pharmacy claims do not have mappings for the detail Referring and Ordering Providers.
  • NCPDP Pharmacy
    • Current Functionality
      • On Claim 1 tab.
      • Other Coverage Code value 0, 1, 4 and 8 do not open both COB 1 and COB 2 tabs.
      • Other Coverage Code value 2 and 3 do open both COB 1 and COB 2 tabs.
    • New Functionality
      • On Claim 1 tab.
      • Other Coverage Code value 0 and 1 will still not open both COB 1 and COB 2 tabs
      • Other Coverage Code Value 2 and 3 will still open both COB 1 and COB 2 tabs.
      • Other Coverage Code value 4 and 8 will now open both COB 1 and COB 2 tabs.

Known Issue with this Release 4.03:

This version includes:

  • Logo change from HPE to DXC Technology
  • The current claims submission logic matches the claim NPI to the ZIP Code and taxonomy. When there are two matches within a region, the logic defaults to the lowest active (default) service location.
  • FFS claims logic will be modified to accept the MPI if the provider sends the value as the secondary identifier in the Billing, Rendering, and Service Facility Location loops/segments and fields. The 10-digit NPI will be matched against the 13-digit MPI to obtain the correct service location. If the Submitted NPI does not match against the submitter 13-digit MPI in the secondary identifier field , an ESC will set
    • The rendering Provider ZIP Code must be sent as part of the Service Facility loop when the provider does not use the Service Facility Provider fields. This applies when the Billing adn Rendering providers are different and will be transparent to the PES software user.
  • MCO encounters logic will be modified to accept the MPI if the provider sends the value as the secondary identifier in the Redering, Billing, and Facility loops/segeents and fields. The secondary identifier will be the 13-digit MPI. If the submitted NPI does not match against the submitted 13-digit MPI in the secondary identifier fild, an ESC will set.
    • The Rendering Provider ZIP Code must be sent as part of the Service Facility Location loop when the provider does not use the Service Facility Provider fields. This applies when the Billing and Rendering providers are different and will be transparent to the PES software user.
  • Pharmacy Changes:
    • The ability for the user to select the value 4 or 8 for the Other Coverage Code field on the Claim 1 tab to open the existing COB 1 and COB 2 tabs. The previous versions of PES only allowed values 2 or 3 to open the COB 1 and COB 2 tabs.
    • The Basis of Reimbursement Determination Code field which displays on the Paid NCPDP Response File will return the pricing code used in calculating the payment amount which displays in the BASIS OF REIMBURSEMENT field. The previous versions of PES displayed the default value of NOT SPECIFIED.

Provider Electronic Solutions Software History

  1. Version 4.01 - Replaces V4.00

  2. Version 4.02 - Replaces V4.01

  3. Version 4.03 - Replaces V4.02

Software Load

  • All new and existing users can use one of the following methods to acquire the new software.

    1. You can download the software free-of-charge by clicking on the Provider Electronic Solutions Software download link.

    2. You can call the Provider Assistance Center at 800-248-2152 or 975-4100 (local calls) to order the software.

Next Steps for New Orders Only

  1. After obtaining the Provider Electronic Solutions Software, you will need to register at the PROMISe™ Transaction Certification Registration Form link below. NOTE: If you previously passed HIPAA/PROMISe™ certification with DXC Technology, you do not have to reregister.

  2. Once you have registered you will receive an email acknowledging that your information has been added to our database. After that, a DXC Technology certification representative will call you to direct you through the certification process.

PROMISe™ Transaction Registration Form

Provider Electronic Solutions Software Download (Version 4.03) - Full Installation. This version is
appropriate for new users.

UPGRADE Provider Electronic Solutions Software - The upgrade is appropriate for submitters currently using version 3.60, 3.61, 4.00, 4.01 or 4.02.

Important note for users applying the upgrade: Prior to running the upgrade, make sure all claims have already been submitted. DO NOT have any claims that are in “Incomplete” or “Ready” status.

*This document is in Adobe PDF format. You must have a copy of Adobe Acrobat Reader installed on your system to view it.

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Last Modified: 10/20/2016