To treat Pennsylvania Medical Assistance (MA) members, whether through fee-for-service or a HealthChoices managed care plan, a provider must first be enrolled in the MA Program. For therapists, the key difference is that behavioral health is managed by a county-assigned plan, separate from physical health. Here is how Pennsylvania Medicaid provider enrollment works, step by step, as of 2026.
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Who Runs Medicaid Enrollment in Pennsylvania
Medical Assistance, Pennsylvania’s Medicaid program, is administered by the Department of Human Services (DHS) through its Office of Medical Assistance Programs (OMAP). New applications go through the online Provider Enrollment Portal, reached from PROMISe, the DHS claims system. Enrolled providers use ePEAP, inside PROMISe, to update addresses, add a group for fee assignment, and upload documents.
How to Enroll, Step by Step
- Find your provider type and specialty on the DHS Provider Enrollment Documents page, which posts a checklist for each.
- Choose a Provider Eligibility Program (PEP), such as Fee-for-Service, or Enrollment Not Paid if you will not bill MA directly.
- Start a new application in the portal. You receive an Application Tracking Number (ATN); write it down.
- Complete the application and upload your documents. DHS warns that you cannot save and return later, so have everything ready.
- Click Submit Application on the Summary page, then track status online with your ATN.
If you cannot apply online, the checklists give a mail, fax, and email address for DHS Provider Enrollment.
Documents Required
For an individual practitioner, the DHS checklists call for:
- A signed provider agreement and an Ownership or Control Interest Disclosure form.
- A copy of your license issued by the Pennsylvania Department of State.
- Proof of current home-state Medicaid participation, for out-of-state providers.
Groups also need an IRS-generated document showing the legal name and FEIN, corporation or partnership papers, and any D/B/A filing. DHS does not accept W-9s.
Screening by Risk Level
- Limited risk: standard screening, including license verification. This covers individual physicians, psychologists, social workers, and dentists.
- Moderate risk: adds unannounced site visits before and after enrollment. Examples include community mental health clinics and partial hospitalization programs. DHS can rely on a Medicare or other-state screening instead.
- High risk: adds FBI and Pennsylvania State Police criminal background checks with fingerprints, including for anyone with a 5% or greater ownership interest, who must submit fingerprints within 30 days of a request.
Is There an Application Fee?
Only institutional providers pay. The federal fee is $750 for applications submitted in calendar year 2026, charged at initial enrollment, reactivation, and revalidation. Individual practitioners are excluded, and the fee is not charged if you are enrolled in Medicare or paid it to another state. Applications under one FEIN within seven days of the first share one fee. Hardship exceptions are decided by CMS, and DHS holds the application meanwhile.
Managed Care: Enroll First, Then Credential
DHS states that MA enrollment does not guarantee a place in any plan network, and some networks may be closed. The physical health HealthChoices plans in the Southeast zone, which includes Philadelphia, are Geisinger Health Plan, Jefferson Health Plans EverWell, Keystone First, UnitedHealthcare Community Plan, and UPMC for You.
Behavioral health is carved out. Under Behavioral HealthChoices, each member is assigned a behavioral health MCO based on county of residence. In Philadelphia, that is Community Behavioral Health (CBH), a county-operated plan under contract with the City of Philadelphia.
Behavioral Health Clinicians
LCSWs (specialty 116) and LSWs (specialty 117) enroll under provider type 11, with a DHS social worker checklist. Psychologists enroll as provider type 19. The DHS provider type list, last updated in March 2024, also includes Licensed Professional Counselor (594) and Licensed Marriage and Family Therapist (593) under provider type 11 and recent MA bulletins refer to enrolled LPCs and LMFTs. DHS posts no separate LPC or LMFT checklist, so confirm the specialty and PEP with Provider Enrollment, and check network requirements with your county’s BH-MCO. Our Pennsylvania behavioral health billing page covers the billing side.
Dentists
Dentists enroll as provider type 27. Individuals add an anesthesia permit and DEA certificate if applicable, and orthodontists submit an Orthodontic Education History form. Public health dental hygiene practitioners must fee assign to a dental or physician group unless they work at an FQHC.
Ordering, Prescribing, and Referring Providers
Since September 25, 2016, DHS has denied fee-for-service claims when the ordering, referring, or prescribing provider is not enrolled in MA. Practitioners who only order, refer, or prescribe can enroll under the Enrollment Not Paid PEP, which means MA fee-for-service does not pay them directly.
Revalidation
Every service location must be revalidated every five years. Check dates in PROMISe and submit the Electronic Revalidation Application at least 60 days early; one application can cover multiple locations. In August 2026, DHS also announced an off-cycle revalidation of high-risk providers, due by December 31, 2026.
How Long It Takes
DHS publishes no guaranteed processing time. In August 2024, OMAP reported processing clean applications in under 30 days, and its dentist enrollment FAQ cites 30 working days for clean applications. Plan credentialing follows enrollment, so allow extra time.
Common Reasons Applications Stall
- Sending a W-9 instead of an IRS-generated document showing the legal name and FEIN.
- Starting the application without every document ready, since it cannot be saved partway.
- Choosing the wrong provider type, specialty, or PEP.
- Errors that force DHS to return the application for corrections.
Let Us Handle Pennsylvania Medicaid Enrollment
Maximum Billing handles Pennsylvania Medical Assistance enrollment, HealthChoices and BH-MCO credentialing, CAQH, and revalidation tracking for Pennsylvania practices. See our behavioral health credentialing services, medical credentialing services, and dental credentialing services, our Pennsylvania medical billing services, or contact us to get started.
This guide reflects official Pennsylvania DHS, OMAP, and CMS information as of October 2026. Requirements change, so confirm current rules with DHS Provider Enrollment before you apply.