MedicaidCoverageHigh impact
MAB2023122001
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Dec 20, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania is retroactively reinstating Medicaid coverage for beneficiaries who were incorrectly terminated due to faulty ex parte renewal processes. Providers can now submit claims for services rendered on or after April 1, 2023, without timely filing restrictions and must refund patients for out-of-pocket payments made during the reinstated coverage period.
Action Required
Immediately: Billing team must identify patients who may have been affected by Medicaid termination after April 1, 2023. Contact Provider Inquiry Service Center at 1-800-537-8862 Option 2, then Option 6, then Option 1 to verify reinstatement dates. Submit claims through PROMISe system for previously uncovered services - these will bypass normal 180-day filing limits and prior authorization requirements. Refund patients for any out-of-pocket payments made during reinstated coverage periods. Monitor for patient notifications about coverage reinstatement.