Community Health Worker (CHW) billing update

As of January 1, 2026, in accordance with direction from the PA Department of Human Services (DHS), Community Health Workers (CHWs) may become certified and bill for CHW services provided to GHP Family members. Review the following requirements to ensure compliance:

Certification

• CHWs must be certified by the Pennsylvania Certification Board https://www.pacertboard.org/cchw.
• Services may be provided without certification but cannot be billed until certification is obtained.

PROMISe ID setup

• Certified CHWs must apply for a PROMISe ID through the state system.
• Link the PROMISe ID to the billing location and supervising provider.
• Both the CHW and the supervising provider must be enrolled with DHS at each location where they may render services to Medical Assistance enrollees.

Billing guidance

• Submit claims using procedure code G0019 at a flat rate of $27.98 per unit.
• Limit of 3 visits per member per year; additional visits are not reimbursed.
• Denials beyond three visits are the provider’s responsibility.
• Both the CHW and the supervising provider must be enrolled with DHS at each location where services are rendered.
• CHW services include health education, care gap closure, navigation to resources, and screening for health-related social needs.
  Excluded services: transportation, housing assistance, case management, childcare, and others listed in Exhibit B(5b) of the 2026 HealthChoices contract.

Documentation

• Document CHW visits in the medical record, including date, time, duration, location, and summary of interventions.
• Monitor compliance and resolve billing issues promptly.

Important notes

• CHW services must be recommended by a licensed practitioner of the healing arts (physician, certified nurse midwife, LCSW, etc.).
• Conditions eligible for CHW services include asthma, COPD, diabetes, heart disease, hypertension, obesity, and others.
• For full details, refer to Exhibit B(5b) of the 2026 HealthChoices contract.
• If you have questions or need assistance, please contact GHP Provider Services at 800-876-5357.