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Region Codes

Claims processed via PA PROMISe™ are assigned a 13-digit Internal Control Number (ICN) upon receipt. The first two digits of the ICN are the region code. This code is used by PA PROMISe™ to denote the type of claim being processed.

PROMISe™ System Region CodePROMISe™ System Region DescriptionPROMISe™ System Use
10Paper claims with no attachments Paper claims that do not include attachments.
11Paper claims with attachmentsPaper claims that include attachments.
20Electronic claims with no attachments Electronic claims that do not include attachments.
21Electronic claims with attachmentsElectronic claims that include attachments.
23Professional Drug ClaimsProfessional Drug Claims
24Professional Drug Claims (Physical Health)Professional Drug Claims (Physical Health)
25Point of Sale ClaimsPoint of Sale Pharmacy claims.
27Internet ClaimClaims submitted through the Internet.
30Encounters Behavioral Health with no attachmentsEncounter Behavioral Health Claims that do not include attachments.
32Encounters Physical Health with no attachmentsEncounter Physical Health Claims that do not include attachments.
35Encounters NCPDP ClaimsEncounters NCPDP Pharmacy Claims
40Claims Converted from old MMISFee For Service Claims that have been converted to the new MMIS from the previous MMIS.
45Converted Claims - Encounter Behavioral HealthEncounter Behavioral Health Claims that have been converted to the new MMIS from the previous MMIS.
46Converted Claims - Encounter Physical HealthEncounter Physical Health Claims that have been converted to the new MMIS from the previous MMIS.
50Single Adjustments - DPW InitiatedSingle Adjustments initiated by DPW.
51Single Adjustments – Provider InitiatedSingle Adjustments initiated by the Provider.
52Mass AdjustmentsMass Adjustments.
53 Void Transaction - TPL from URSVoid Transaction - TPL from URS
54Void Transaction - TPL from ContractorVoid Transaction - TPL from Contractor
55Mass Adjustments – Provider RatesMass Adjustments of Provider Rate Changes
59Reversal Adjustment.Reversal of a Claim {Point of Sale, 837}
60Converted Adjustment Claims – FFSFee For Service Adjustment Claims that have been converted to the new MMIS from the previous MMIS.
65 Converted Adjustment Claims - Encounter Behavioral Health Encounter Behavioral Health Adjustment Claims that have been converted to the new MMIS from the previous MMIS.
66Converted Adjustment Claims - Encounter Physical HealthEncounter Physical Health Adjustment Claims that have been converted to the new MMIS from the previous MMIS.
69Internet AdjustmentsAdjustments submitted through the Internet.
70Single Adjustments - Encounters Behavioral HealthSingle Adjustments for Encounters Behavioral Health claims.
71Single Adjustments - Encounters Physical HealthSingle Adjustments for Encounters Physical Health claims.
72Mass Adjustments - Encounters Behavioral HealthMass Adjustment for Encounters Behavioral Health claims.
73Mass Adjustments - Encounters Physical HealthMass Adjustment for Encounters Physical Health claims.
74Mass Adjustments - Provider Rates Encounters Behavioral HealthMass Adjustment of Provider Rates for Encounters Behavioral Health claims.
75Mass Adjustments - Provider Rates Encounters Physical HealthMass Adjustment of Provider Rates for Encounters Physical Health claims.
76Single Adjustments – Encounters Behavioral Health Provider InitiatedSingle Adjustments for Encounter Behavioral Health claims that were initiated by the Provider.
77Single Adjustments – Encounters Physical Health Provider InitiatedSingle Adjustments for Encounter Physical Health claims that were initiated by the Provider.
79Reversal Adjustment – NCPDP EncountersReversal of a NCPDP Encounter Claims
80Paper claims reprocessed by EDS Systems EngineerClaims that have been reprocessed by an EDS Systems Engineer.
85Electronic Claims reprocessed by EDS Systems EngineerClaims that have been reprocessed by an EDS Systems Engineer.
86BPI Initiated AdjustmentAdjustment initiated by BPI
87BPI Contractor Initiated AdjustmentAdjustment initiated by BPI Contractor
90Special Handling claimsUsed to indicate claims that have been submitted for special handling. This would be items such as 180 day exception, do not reject, or process file copies.

Last modified on: October 9, 2007