Medicaid

How to Get Credentialed with Pennsylvania Medical Assistance in Pennsylvania

Network: Open
30-60 Days

Quick Overview

Timeline

30 - 60 days

CAQH

Not Required

Re-credentialing

Every 5 year(s)

Delegated

No

Pennsylvania-Specific Requirements

Pennsylvania Medicaid (HealthChoices) enrollment steps: (1) Obtain NPI via NPPES. (2) Register through the DHS (Department of Human Services) PROMISe (Provider Reimbursement and Operations Management Information System in Electronic) provider enrollment portal. (3) Submit application with PA state license, proof of malpractice insurance, and required documentation. (4) Complete three background checks: Act 34 (PA State Criminal History), Act 151 (Child Abuse History Clearance), and FBI fingerprint check required for all providers. Pennsylvania operates managed care through HealthChoices with 5 MCOs per geographic zone. Behavioral health providers accepted include LPC, LCSW, and LMFT with active Pennsylvania licensure. Revalidation is required every 5 years.

Medicaid Information — Pennsylvania

Agency: Pennsylvania DHS

Program: Medical Assistance (MA)

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

Phone: 1-800-537-8862

Step-by-Step Enrollment Process

1

Gather Required Documents

Collect all necessary credentials including your medical license, DEA certificate, malpractice insurance, NPI number, and any state-specific requirements for Pennsylvania.

2

Prepare Your Application

Complete Pennsylvania Medical Assistance's provider enrollment application with all required information and supporting documentation.

3

Submit Your Application

Submit your completed enrollment package to Pennsylvania Medical Assistance.

4

Track & Follow Up

Credentialing typically takes 30-60 days. Monitor your application status and respond promptly to requests for additional information.

Required Documents Checklist

Background Check

Federal/state background check required for Medicaid enrollment

CV/Resume

Work history required

FINGERPRINT_CLEARANCE

PA Act 114 FBI Fingerprint Clearance

Malpractice Insurance

Conditional

Required in most states; some state programs waive for government employees

Medical License

NPI Certificate

STATE_CLEARANCE

Conditional

PA state clearances required for all providers

PA Act 34 Criminal Background Check; PA Act 151 Child Abuse History Clearance

Enrollment Forms

Pennsylvania Medicaid Provider Enrollment (PROMISe)

Required
Online Open →

Contact Information

Provider Enrollment

National

1-800-537-8862

General Provider Inquiries

National

1-800-537-8862

Quick Links

Provider Portal

Need Help?

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Other Payers in Pennsylvania

Aetna UnitedHealthcare Cigna Healthcare Anthem / Elevance Health Humana Centene Corporation Molina Healthcare Highmark Blue Cross Blue Shield (Western PA) Independence Blue Cross UnitedHealthcare Community Plan
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