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of the Commonwealth of Pennsylvania

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    Enrollment information, including a link to the Online Provider Enrollment application and requirements, as well as the Electronic Provider Enrollment User Manual, can be found on the Provider Enrollment Information Page.

    Providers must first logon to the PROMISeTM Provider Portal to access 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 PROMISeTM Provider Portal to access the Electronic Revalidation Application, which is available from the "My Home" page in the Provider Services section on the left.  

    Providers closed for two years or less must first logon to the PROMISeTM Provider Portal to access the Electronic Reactivation Application, which is available from the "My Home" page in the Provider Services section on the left.  Providers closed for more than two years can access the revalidation application from the portal home page without logging in.

    Providers must first logon to the PROMISeTM Provider Portal to access the Electronic Change Request Application, which is available from the "My Home" Page in the Provider Services section on the left. 

    Providers must first logon to the PROMISeTM Provider Portal to terminate their enrollment in Medicaid.  The "Terminate Enrollment" link is available from the 'My Home" page in the Provider Services section on the left.

    Providers must first logon to the PROMISeTM Provider Portal here: (https://promise.dpw.state.pa.us/) to access their Enrollment Summary, which also includes the following information:

    • Active Service Locations: Users may download an extract of all active service locations associated with their 9-digit provider ID which includes the following fields: 13-digit provider ID, NPI, revalidation date, provider type, name, address, specialties, and taxonomy codes.
    • Fee Assignments: Group providers may also download an extract of all providers associated with the group service location within the last two years.  Fields include: group provider ID, individual provider ID, NPI, revalidation date, provider type, fee assignment effective date, fee assignment end date, name, and address.

    An individual is a sole practitioner who is enrolled under his or her own social security number or IRS (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 MA 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. 

    You may contact Provider Enrollment by calling 1-800-537-8862.  Follow the prompts to reach an enrollment representative.  Hours of Operation are Monday through Friday, 8 a.m.-4:30 p.m.

    Remember, Provider enrollment information is available on the Provider Enrollment Information page of the DHS website.