How to become a Medicaid provider in Pennsylvania
To bill Pennsylvania Medicaid, enroll through PROMISe Provider Portal — Electronic Provider Enrollment (PE) Application, run by PROMISe. The process has 6 steps, listed below with the documents the state asks for.
- Enrollment portal
- PROMISe Provider Portal — Electronic Provider Enrollment (PE) Application
- Steps
- 6
- Documents
- 5
- Plans listed
- 8
On this page
Pennsylvania Medicaid enrollment at a glance
To bill Pennsylvania Medicaid, enroll through PROMISe Provider Portal — Electronic Provider Enrollment (PE) Application, run by PROMISe. The process has 6 steps, listed below with the documents the state asks for.
- Program
- Pennsylvania Medical Assistance (Medicaid) / HealthChoices, PA Department of Human Services, Office of Medical Assistance Programs
- Fiscal agent
- PROMISe (DHS claims and enrollment system); the DHS electronic enrollment manual was prepared by Gainwell
- Application fee
- Since February 27, 2023, applicants pay the enrollment application fee described in MA Bulletin 01-16-14 ('ACA Enrollment Application Fee'). To claim an exemption, submit the documentation that bulletin describes. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.
- Fingerprinting
- High-risk providers must complete fingerprint-based criminal background checks; this requirement returned February 27, 2023 (MA Bulletin 99-16-13 sets the risk levels). If fingerprints are not submitted, the service location in PROMISe is closed. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.
- Site visit
- Moderate- and high-risk providers get a site visit from DHS or its contractor (MA Bulletin 99-16-13). If the visit cannot confirm the application, for example because the location is not operating, or the provider does not cooperate, the service location is closed.
- Revalidation
- Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years. DHS sends revalidation notices 90 and 30 days before the due date (MA Bulletin 99-16-10 has the details). The revalidation date is visible in ePEAP. A missed due date closes the service location in PROMISe, and the provider must then file a reactivation application.
- Provider manual
- Provider manual
Steps
- Get an NPI
- Open the Electronic PE Application from the PROMISe Provider Portal landing page (no login needed for new applications or reactivations of locations closed 2+ years)
- Fill out the pages shown for your provider type and specialty, including background checks, and upload required attachments
- Accept the agreements, pay the application fee or document an exemption, and submit
- Complete fingerprinting and the site visit if your risk level requires them
- Join HealthChoices or Community HealthChoices plan networks separately
Documents the state asks for
Joining managed-care plan networks
- Credentialing
- Medical Assistance enrollment through PROMISe is separate from joining HealthChoices managed care. Providers contract and credential with each MCO. The DHS pages we reviewed describe no centralized credentialing.
- Plans (state list)
- AmeriHealth Caritas Pennsylvania
- AmeriHealth Caritas Northeast
- Geisinger Health Plan
- Highmark Wholecare
- Jefferson Health Plans EverWell
- Keystone First
- UPMC for You, Inc.
- United Healthcare Community Plan
Frequently asked questions
How do I become a Medicaid provider in Pennsylvania?
To bill Pennsylvania Medicaid, enroll through PROMISe Provider Portal — Electronic Provider Enrollment (PE) Application, run by PROMISe. The process has 6 steps, listed below with the documents the state asks for.
Is there an application fee to enroll in Pennsylvania Medicaid?
Since February 27, 2023, applicants pay the enrollment application fee described in MA Bulletin 01-16-14 ('ACA Enrollment Application Fee'). To claim an exemption, submit the documentation that bulletin describes. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.
How often must Pennsylvania Medicaid providers revalidate?
Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years. DHS sends revalidation notices 90 and 30 days before the due date (MA Bulletin 99-16-10 has the details). The revalidation date is visible in ePEAP. A missed due date closes the service location in PROMISe, and the provider must then file a reactivation application.