Enroll as a Medicaid Provider
Health care providers including doctors, nurses, dentists, hospitals, clinics, pharmacies, and other health care facilities can apply to provide services through Medicaid.
Once approved, Medicaid providers can deliver services to Pennsylvanians who are covered by Medicaid and receive reimbursement from the program for services provided, including a range of medical, dental, and behavioral health services.
Eligibility
Eligibility
- To be eligible for enrollment as a Medicaid provider, practitioners in Pennsylvania must be licensed and currently registered by the appropriate state agency.
- Out-of-state practitioners must be licensed and currently registered by the appropriate agency in their state, and they must provide documentation that they participate in that state's Medicaid program.
- Other providers must be approved, licensed, issued a permit, or certified by the appropriate state agency, and, if applicable, certified under Medicare.
Please Note: Enrollment in the Medicaid program does not guarantee enrollment in individual managed care organization (MCO) networks. New providers should contact each MCO directly to explore their provider network needs. Some MCO provider networks may be closed due to network adequacy.
Criminal Background Check
The Pennsylvania Department of Human Services (DHS) has assigned certain provider types and specialties to the "high" categorical risk level. The Affordable Care Act (ACA) requires all providers deemed to be a high categorical risk level to obtain criminal background checks, which include a Federal Bureau of Investigation (FBI) criminal background check and a Pennsylvania State Police Criminal Record Check. Any person with a five percent or greater direct or indirect ownership interest in the high-risk provider must also submit criminal background check information. For more information, please see MA Bulletin 99-17-03 or visit the Office of Medical Assistance Programs (OMAP) section of the Provider Clearances and Background Checks page.
To access enrollment or revalidation applications and requirements for each provider type, visit the Provider Enrollment Documents page.
Enrollment Process
You can apply on the PROMISe Provider Portal located on the left-hand side of the Homepage, under Provider Enrollment.
A unique number called the Application Tracking Number (ATN) will be assigned when a New Application or Reactivation is started.
Prior to exiting the application, write down this number, and keep it for your records.
Please note: you cannot save your application and return to it later. Make sure that you complete the application, supply the required supporting documentation, and click "Submit Application" on the Summary page when you are finished.
Enroll Now
Applying online is the quickest and easiest way to enroll.
Using our PROMISe Provider Portal, you can submit a:
- New Application - A brand new provider never enrolled with PA Medicaid and/or CHIP or a new service location for a provider closed for more than two years.
- Reactivation - Activating an enrolled service location that is currently closed for more than two years.
- Resume Application - Enter your application tracking number (ATN), Federal Tax Identification Number (FEIN) or Social Security Number (SSN), and password to resume your existing provider enrollment application.
- Application Status - Enter your application tracking number (ATN), Federal Tax Identification Number (FEIN) or Social Security Number (SSN), and password to review your application status.
Frequently Asked Questions
Detailed enrollment information, including the application and requirements, as well as the Electronic Provider Enrollment User Manual, can be found on the PROMISe Provider Portal.
Providers must first logon to the PROMISe Provider Portal then complete the Electronic Revalidation Application, which is available from the "My Home" page in the Provider Services section on the left.
Providers must first logon to the PROMISe Provider Portal then complete the Electronic Provider Enrollment Application for a new service location, which is available from the "My Home" page in the Provider Services section on the left.
An individual is a sole practitioner who is enrolled under his or her own social security number or IRS FEIN (if incorporated as an individual). The individual may or may not be associated with a group practice or group practices.
Group practices are professional corporations or partnerships composed of individual practitioners of the same provider type. Group enrollments were created to permit individually enrolled practitioners to assign their fees to group practices with which they are associated.
The group practice must be enrolled as a group provider, but may not bill for services as a rendering provider. When invoicing for payment, the Medicaid number of the individual practitioner who performs the service must be identified as the rendering provider. The group number is used to identify the entity to which the payment will be made/assigned.
Contact
If you have questions, you can speak to an enrollment specialist, Monday through Friday, 8:00 A.M. - 4:30 P.M.