Please close your LIHEAP session and try again. If this issue persists, please contact the PROMISe Provider Assistance Center (PAC) by calling 1-800-248-2152 to inform them of this error.

Please close your LIHEAP session and try again. If this issue persists, please contact the PROMISe Provider Assistance Center (PAC) by calling 1-800-248-2152 to inform them of this error.

PA Department of Human Services DHS Heating Assistance / LIHEAP  
 
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Entering LIHEAP Credits Desk Guide.                        
     
LIHEAP Claim                           Need help submitting a claim?  View sample claim submissions here.
Billing Information
Vendor: Attachment Control #:
 Crisis Authorization #:
 Delivery Date (MM/DD/YYYY):

NOTE: Please correct Customer Acct # if incorrect.

Customer Account #: Crisis Claim Total:
Last Name:
  "Crisis Claim Total" is based on Service Code entries below. For non-utilities, if the value of this field is greater than the Available Crisis Funds displayed on the Worklist, the claim will be DENIED.
First Name:
Middle Initial:
Service Lines for this Authorization #
Delivery
Date		Service
Code		Basis of
Measurement		UnitsPrice
per Unit		Amount

Enter delivery or termination details here.

Service Code Y9012 credits/other payments is a negative (-) entry so it CANNOT be the first code entered. Each Service Code may only be used once per claim. If more than one item, associated with this claim applies to the same Service Code, combine the quantity and cost information and enter as one detail line. Questions? Contact the Vendor Unit at 877-537-9517.

Service Code:
Basis of Measurement:
Units:
Price per Unit:
Total for this Service Code:

 
           
 
Claim Status Information
Claim Status