Are you interested in providing tobacco cessation services for your patients?

There are three (and more to come) pathways for the provision and billing of tobacco cessation services. 

•  UnitedHealth Care
•  Health Partners Plans
•  Keystone Health 

Pharmacists must follow these steps to bill! Registering with DHS can take several weeks to process, so get started now! 

 

Steps to Provide Tobacco Cessation Services in Pennsylvania Medicaid

If you, as a pharmacist, do not have an individual NPI number, getting one should really be your first step, before proceeding.  You can get your NPI number at:  https://nppes.cms.hhs.gov/#/

 

If you already have an NPI, please follow this guide:

 

Each individual pharmacist who may plan to provide counseling services must do this individually.

 

Step 1- Complete Every Smoker, Every Time Webinar.

Complete Every Smoker, Every Time webinar.  Every Smoker, Every Time is a free online training providing entry level tobacco use-related education for behavioral and primary health care staff, pharmacists, counselors, social workers, and others. Every Smoker, Every Time includes information on effective brief intervention, nicotine replacement therapy (NRT), and referral options. You can complete the Every Smoker, Every Time training (45 minutes) at your convenience and receive a Notification email after passing a post-test with a score of at least 80%.

 

The training is based on effective, validated tobacco dependence treatments and practices found in the AHRQ guidelines, Treating Tobacco Use and Dependence: 2008 Update – Clinical Practice Guide.Successful completion of the Every Smoker, Every Time webinar generates the Notification Email required for Pre-Approved Tobacco Cessation Registry application and the Department of Human Services Medical Assistance (DHS MA) provider application. The Notification Email will be sent automatically upon successful completion of the webinar.

Visit the site HERE.

 

For questions regarding the Every Smoker, Every Time webinar, please email: RA-Registry@pa.gov

Step 2 - Complete the Pre-Approved Tobacco Registry application.  

Complete the Pre-Approved Tobacco Cessation Registry application: (scroll to application link on the below page)

 

https://www.health.pa.gov/topics/programs/tobacco/Pages/Registry.aspx

https://www.health.pa.gov/topics/Documents/Programs/Tobacco/Registry%Application%Instructions%Aug%2018.pdf

 

Print, sign and email, with the Notification Email, to Department of Health (DOH) RA-Registry@pa.gov.  When you check the box to be referred to DHS MA, your Pre-Approved Tobacco Cessation Registry application and Notification Email will be forwarded to DHS MA. 

You must check yes on the following:

“If your program is approved, would you like to be referred to the Department of Human Services (DHS) for review and approval by Medical Assistance for reimbursement of tobacco cessation services? ☐Yes ☐No”

 

Making sure you follow these instructions carefully will expedite the process - DOH will send a fax to confirm your application has been approved and a link to the DHS MA application for the PROMISe number.  Pharmacists must then apply for an individual PROMISe number as a Tobacco Cessation Counselor.  Please wait to receive this FAX before proceeding.

Step 3 - Enrollment with DHS and Obtaining a PROMISe Number

Pharmacists are required to have an NPI number prior to applying to DHS MA for the PROMISe number.

 

There are several ways to access the DHS MA PROMISe number application.  The following link provides the Online Application, and the Tobacco Cessation Provider Requirements.  We will walk through the Online Application process then explain the Tobacco Cessation Provider Requirements.

 

https://www.dhs.pa.gov/providers/Providers/Pages/Provider-Enrollment-Docs.aspx

 

Be sure to scroll down to 37 – Tobacco Cessation Provider: Select Online Application

Select New Application on left side menu

 

Initial Enrollment Information

               Program Type: Select Pennsylvania Medical Assistance (PA MA)

               Provider Type: Select 37 – Tobacco Cessation  (Specialty 370)

               Enrollment Type: Select Individual with SSN

Tax Identifier

               Use your Social Security as the Tax Identifier

Name of Enrollee

               Use Individual’s Name

Medicare Enrollment Information

               Are you a Medicare participating Provider? Select NO

Contact Information

               Enter all required fields

Complete the application. 

 

Requirements for Provider Type 37 – Tobacco Cessation: please see the attached document for requirement explanation and instruction. This document includes DHS Provider Enrollment contact information.

 

Be sure to fee assign billing/payment to your pharmacy using their 13 digit PROMISe number.

 

Click here for the document.

Sample Application

Click here for the document

 

The Medical Assistance Bulletin Enrollment of Tobacco Cessation Providers 99-18-10 provides additional pertinent information.

 

Click here for the Bulletin

 

When submitting your application and including your ESET certificate, we suggest writing on the certificate pdf the pharmacy that the you are employed by and that will be actually submitting the billing.  This way DHS can appropriately flag and set this up on the pharmacy file.

 

The DHS MA system automatically sends a PROMISe welcome letter which provides the 13-digit PROMISe number.  The normal time-frame is approximately three to four weeks from application to welcome letter.

DHS will inform DOH that the PROMISe number has been issued at which time DOH will place the applicant on the Pre-Approved Tobacco Cessation Registry.  This may take several weeks to complete.

 

For Department Information on Fee for Service billings, click on each of the below bulletins:

 

 

The Medical Assistance Bulletin New Procedure Codes for Tobacco Cessation Counseling Services 99-12-09. 

 

Click here for the Bulletin

 

MA Bulletin 99-18-10 was issued to reinforce that any provider can enroll to render TCC services.

 

Click here for that Bulletin.

Click here for the provider quick tips from DHS

 

Step 4 Create a CAQH ProView Account

Some payers require that pharmacists are credentialed and contracted via a credentialing database, CAQH ProView, in order to bill for tobacco cessation services. Pharmacists should create a free CAQH ProView profile using the attached instructions provided by CPESN Tennessee. 

 

Click here to access the instructions

 

 

Step 5 (Optional) - Refresh Your Tobacco Cessation Knowledge

PPA has a two-hour CE training program (free to members) available to enhance your knowledge and skills around delivery tobacco cessation counseling programs.  It is presented online, on demand, in two modules, and can be done in increments.  You will receive the CE credit when both modules and related assessment questions are completed.  They are not required by fee-for-service Medicaid but will provide a nice reference and framework to help you get started!

 

Click here to access the training program.

 

Disclaimer

We realize this seems like a complicated process but please try to follow it carefully.  If you experience any challenges - please let PPA know.  We worked with both DOH and DHS to try and make this as smooth as possible.  Unfortunately much of it is out of our hands.

 

Step 6 - Get Signed on with MCO Plans

Each payer has a different process, click here to learn more:  Sign on with Medicaid Payers

 

More Resources: 

 

Tobacco Use Prevention and Cessation Counseling Coding Reference

 

American Lung Association; Billing Guide for Tobacco Screening and Cessation