Enrollment Information
In order for providers to participate with the Department of Human Services (DHS), they must first enroll.
- To be eligible to enroll, 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 state Medicaid does not guarantee enrollment in individual MCO Networks. New providers should contact each MCO directly to explore their provider network needs as some MCO provider networks may be closed due to network adequacy.
Online Provider Enrollment Application
Use the Online Provider Enrollment portal to submit a new application, for revalidation, or for reactivation.
Benefits of using the secure online portal:
- Allowing documents to be uploaded directly to the portal
- Permitting providers see the status of their submission
- Decreasing wait time to review applications
Instructions for navigating the portal - use the Online Provider Enrollment portal to view the Internet Help Manual.
Criminal Background Check
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.
Enrollment Forms
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My company has had a change of ownership or control interest:- Without a change in the enrolled IRS tax number:
- With a change in the enrolled IRS tax number, please submit the following:
All documents and inquiries related to changes of ownership/control interest, officers/board members, tax id, etc. should be sent to RA-pwProvCHOW@pa.gov If you have any other enrollment-related questions, please call the appropriate phone number shown on the Medical Assistance Desk Reference |