Credentialing Services in Pennsylvania

In Pennsylvania, a clinician can be fully enrolled in Medical Assistance and still be out of network with the plan that pays for a patient’s care. Physical health and behavioral health run through different managed care organizations, and behavioral health is assigned by county. Maximum Billing provides credentialing services for Pennsylvania practices, covering Medical Assistance enrollment, HealthChoices and Behavioral HealthChoices plans, commercial plans, Medicare, and CAQH, through revalidation years later.

Schedule a consultation or call 800-820-0364.

Client results as of 2026. Request a billing review.

What Our Pennsylvania Credentialing Services Include

• Network planning: which commercial plans, Medicare options, HealthChoices plans, and county behavioral health plans your practice actually needs.
• Medical Assistance enrollment through the DHS Provider Enrollment Portal, including the right provider type, specialty, and Provider Eligibility Program.
• NPI and taxonomy checks before any application is submitted.
• CAQH ProView setup, document uploads, and re-attestation.
• Managed care applications with the physical health and behavioral health plans, with follow-up until each one is decided.
• Medicare enrollment through PECOS, with benefits reassigned to your group.
• Contract review before you sign, covering rates, effective dates, and telehealth.
• Five-year revalidation and re-credentialing tracked for every location and clinician.

Medical Assistance Enrollment Comes First

Pennsylvania’s Medicaid program, Medical Assistance, is run by the Department of Human Services through its Office of Medical Assistance Programs. First-time applications are filed in the DHS online Provider Enrollment Portal, and once enrolled, providers make address changes, group additions, and document uploads in ePEAP, part of PROMISe. The application cannot be saved partway, so every document needs to be ready before it starts. DHS does not accept a W-9; groups submit an IRS-generated document showing the legal name and FEIN instead. Our Pennsylvania Medicaid provider enrollment guide covers each step.

HealthChoices and Behavioral HealthChoices

DHS states plainly that being enrolled in Medical Assistance does not entitle a clinician to a spot in any plan’s network, and some networks are closed. Each plan is a separate credentialing process. For physical health in the Southeast zone, which takes in Philadelphia, the HealthChoices plans are:

• Geisinger Health Plan
• Jefferson Health Plans EverWell
• Keystone First
• UnitedHealthcare Community Plan
• UPMC for You

Behavioral health sits outside those plans, in Behavioral HealthChoices, where the member’s county of residence decides which behavioral health MCO they belong to. Philadelphia residents are covered by Community Behavioral Health, which the City of Philadelphia contracts and the county operates. A therapy practice serving several counties may need contracts with several behavioral health plans.

Behavioral Health Credentialing in Pennsylvania

Pennsylvania enrolls LCSWs and LSWs under provider type 11 and psychologists under provider type 19. The DHS provider type list also includes licensed professional counselors and licensed marriage and family therapists, but DHS posts no separate checklist for them, so we confirm the specialty and eligibility program with Provider Enrollment before applying, and check each county plan’s network requirements. See our mental and behavioral health credentialing services and Pennsylvania mental health billing services.

Dental and Prescribing Clinicians

Dentists enroll as provider type 27, adding an anesthesia permit and DEA certificate where they apply, and orthodontists submit an Orthodontic Education History form. For clinicians whose only role is ordering, referring, or prescribing, the Enrollment Not Paid program is the route; since September 25, 2016, DHS has denied fee-for-service claims naming an unenrolled ordering, referring, or prescribing clinician. See our dental credentialing services and medical credentialing services.

Revalidation in Pennsylvania

Every service location must be revalidated every five years, with the electronic revalidation application submitted at least 60 days early. DHS has also called an off-cycle revalidation for high-risk providers, announced in August 2026 and due by December 31, 2026. We track location by location so no address quietly lapses.

How Long It Takes in Pennsylvania

There is no guaranteed turnaround from DHS. OMAP said in August 2024 that clean applications were being processed in less than 30 days, and the dentist enrollment FAQ gives 30 working days. Plan credentialing follows enrollment and adds its own time, so practices should start well before a clinician’s first patient.

What Slows Pennsylvania Credentialing Down

• Sending a W-9 when DHS needs an IRS-generated FEIN document.
• Opening the application before every document is ready.
• Choosing the wrong provider type, specialty, or eligibility program.
• Assuming Medical Assistance enrollment means plan network participation.
• Missing the county behavioral health plan for a client’s county.

Frequently Asked Questions

Does Medical Assistance enrollment put me in a HealthChoices network?

No. DHS states that enrollment does not guarantee network participation, and each plan credentials separately.

Which plan handles behavioral health for Pennsylvania Medicaid members?

Behavioral HealthChoices assigns the plan by the member’s county. For Philadelphia residents, it is Community Behavioral Health.

Can LPCs and LMFTs enroll in Pennsylvania Medical Assistance?

The DHS provider type list includes them, but there is no separate DHS checklist, so we confirm the specialty and eligibility program with Provider Enrollment first.

How often do Pennsylvania locations revalidate?

Every five years for each service location, with the application due at least 60 days before the deadline.

Credentialing for Pennsylvania Practices

Tell us your clinicians, counties, and the plans you want to join, and we will lay out the order of applications. We also handle Pennsylvania medical billing once contracts are active. See our credentialing and payer enrollment services, or contact us to get started.