MedicaidAdministrativeMedium impact
MAB1996022901
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Feb 29, 1996
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance has established procedures to ensure continuity of prior-authorized services for recipients under age 21 when they transfer between fee-for-service and managed care plans. Providers must verify eligibility through EVS before each visit and follow specific billing procedures based on the recipient's current plan enrollment status.
Action Required
Immediately: Pennsylvania providers must check EVS (Eligibility Verification System) before providing any service to Medical Assistance recipients and listen to the entire message. When recipients transfer between fee-for-service and managed care plans, follow the specific billing procedures outlined for each scenario - notify the appropriate plan of existing prior authorizations, submit invoices with proper attachments, and ensure continuity of previously authorized services through the original approval period.