Providers who render, order, refer, or prescribe items or services to Children’s Health Insurance Program (CHIP) members must have an active Provider Reimbursement and Operations Management Information System Identification (PROMISe™ ID) on file with the Commonwealth of Pennsylvania Department of Human Services (DHS) and Highmark for their provider type and for each service location where they see CHIP enrollees.
You must ensure that your information is always up to date and you are enrolled for all locations where you provide services.
Effective July 1, 2019, Highmark is required to deny claims if we are unable to match the provider’s NPI reported on the claim to a PROMISe enrollment record for the service location where the services were performed.
In addition, you are required to select a PROMISe ID-enrolled provider when submitting any authorization requests for referrals in NaviNet®.
Special eBulletin
dated June 10, 2019 has more information, including PROMISe ID enrollment information and applications, FAQs, and links to information about CHIP in the Highmark Provider Manual.
