Pennsylvania Provider Enrollment - Frequently Asked Questions
Who needs to enroll in Pennsylvania Medicaid?
In order for providers to participate with the Department of Human Services, they must first enroll. To be eligible to enroll, practitioners in Pennsylvania must be licensed and currently registered by the appropriate state agency. Provider enrollment is a federal requirement that the PA Department of Human Services is implementing due to the Affordable Care Act (ACA) provision which requires all providers who render, order, refer, prescribe or bill for items or services to CHIP enrollees to have enrolled with the Department by 12/31/17.
How do I enroll?
To enroll, providers can complete an on-line provider enrollment application and supply any required supporting documentation. This includes providers who are not billing PA Medicaid or CHIP but provide services to beneficiaries. All applications will be screened based on Federal and State guidelines prior to an enrollment decision. Please retain copies of your application materials for your records. You will receive a response upon approval or denial of your enrollment with PA Medicaid and/or CHIP.
What types of Provider Enrollment Applications are there?
There are three types of enrollment applications and each requires a provider to complete an entire application. Please click the appropriate navigation item on the left hand side of the page to start a “New Application”, “Revalidation” or “Reactivation”.
- "New Application" - A new service location address or a brand new provider never enrolled with PA Medicaid and/or CHIP.
- "Revalidation" - An active service location for a provider currently enrolled with PA Medicaid and/or CHIP that requires verification of information per Federal or State regulation.
- "Reactivation" - Activating an enrolled service location that is currently closed with PA Medicaid and/or CHIP.
How do I Track my Provider Enrollment Applications?
A unique number called the "Application Tracking Number" (ATN) will be assigned when a "New Application", "Revalidation" or "Reactivation" is started. Prior to exiting the application, write down this number and keep it for your records. If you need to access the application later, please click the appropriate navigation item on the left hand side of the page to "Resume Application" or to check the "Application Status". Note: Information will not be retained and the application will be deleted if the provider does not complete the application, supply the required supporting documentation and click the "Submit Application" button on the "Summary" page when finished.
Who should I contact with further questions?
You may contact the PROMISe Provider Assistance Center (PAC) at 1-800-248-2152 for questions regarding provider enrollment.
For questions concerning why Envolve has requested you take action, please contact Customer Service at 844-524-8255.