Pennsylvania Medical Assistance Provider Enrollment and Credentialing: PROMISe, HealthChoices MCOs, BH-MCOs and Novitas JL Medicare

A Pennsylvania practice usually needs every row below, each filed and approved on its own. The timing column repeats only what the agency, contractor or plan has written down.

Physicians are licensed by the State Board of Medicine through the Pennsylvania Licensing System (PALS), which is also where a license is looked up; the Board itself provides direct source verification only to another state's licensing agency (Board resources page). The PROMISe portal now checks Department of State, DEA and CLIA records at the source and no longer asks for an upload when the record verifies.

Pennsylvania's rule is simple to state and easy to get wrong in practice: a provider must enroll before participating, and DHS treats the enrollment as belonging to a service location. The PROMISe provider portal landing page is the front door. New providers, and providers whose enrollment has been closed for more than 2 years, use the links on the left of that page; an active provider, or one closed for less than 2 years, must log in to the portal first and start the application from inside. The sequence:

1. Find your provider type and read its requirements sheet. DHS numbers its provider types (09 CRNP, 10 midlevel practitioner, 11 mental health and substance abuse, 15 chiropractor, 17 therapist, 19 psychologist, 31 physician and physician group, among others) and posts a requirements document for each on the provider enrollment documents page. For a physician (type 31) the sheet lists specialty codes such as 316 Family Practice, 322 Internal Medicine and 339 Psychiatry, and the Provider Eligibility Program each can join: Fee-for-Service, Enrollment Not Paid (for clinicians who order and refer but never bill), and Healthy Beginnings Plus for maternity care.
2. Choose New Application (or Reactivation if a closed location is coming back). The portal issues an Application Tracking Number as soon as the application starts; write it down, because resuming the application and checking its status both require it, together with the provider's SSN or FEIN and the password you set.
3. Enter the practice, the owners and every service location. Each address where Medical Assistance patients are seen is its own enrollment with its own service-location extension on the 13-digit ID, and Quick Tip 173 says locations must be enrolled "prior to seeing any MA patients," even for a practice that will only bill the HealthChoices plans (Quick Tip 173).
4. Upload what the portal still asks for. Since the portal began verifying licenses at the primary source, the uploads that remain are the ones DHS cannot pull itself; the documents section below lists what a physician file contains.
5. Pay the application fee if your provider type owes one, or upload a hardship request. The fee is collected before the provider agreement is executed.
6. Sign the provider agreement and submit. The landing page warns that information is not retained and the application is deleted if the provider does not complete it, supply the documentation and click Submit.

Every application is screened under federal and state rules before a decision, and DHS responds by email with the approval or the denial. Under 55 Pa. Code 1101.43(c) the notice is in writing, payment runs only from the agreement's effective date forward, and a denied applicant may appeal under the Administrative Agency Law. Paper applications still exist for a short list of provider types; DHS asks those providers to call 1-800-537-8862 for the form.

The feature that distinguishes Pennsylvania from most states is the location-level ID. On December 19, 2018 DHS issued Medical Assistance Bulletin 99-18-11 reminding providers to enroll each service location, and Quick Tip 219 spells out the enforcement: from July 1, 2019, PROMISe reads the NPI, the taxonomy and the nine-digit ZIP code on an electronic claim, looks for an enrolled location that matches, and denies the claim when it finds none. The requirement rests on the Affordable Care Act screening rules, because each practice site has to be screened, and it applies to providers who participate only through a managed care organization.

The HealthChoices plans police the same rule from their side. UPMC Health Plan's July 27, 2023 notice told its network that for dates of service from September 1, 2023 "all service locations must comply with the reinstated PROMISe ID enrollment requirements to avoid claim denials," naming UPMC for You, UPMC for Kids and UPMC Community HealthChoices, and told providers to enroll any location that does not appear in PROMISe. AmeriHealth Caritas Pennsylvania's credentialing page asks for the PROMISe Provider Identification Number and for every service location to be registered with DHS under a different extension.

Three housekeeping forms follow from this design, all linked from the DHS enrollment page: the Service Location Change Request (closing a location, changing the mail-to, pay-to or 1099 address, ending an assignment of fees), the Provider Practice Relocation Request, and the Individual Request for Assignment of Fees that ties a clinician's payments to a group. Quick Tip 173 adds a plain instruction practices forget: close locations you no longer use, and keep the NPI on file with DHS identical to the one on file with every MCO.

The DHS requirements sheet for provider type 31 lists what the Bureau of Fee-for-Service Programs needs to enroll an individual physician: the completed individual application with a signed provider agreement, the Ownership or Control Interest Disclosure form, a copy of the Department of State license, a copy of the DEA certificate, board certification where applicable, and, for anyone billing laboratory services, both the CLIA certificate and a Pennsylvania Department of Health clinical laboratory permit, which DHS requires of in-state and out-of-state providers alike. Mammography, diabetes-training and fluoride-varnish certificates are added only when the practice performs those services.

Ownership disclosure is not a formality here. 55 Pa. Code 1101.43(b) requires a medical facility to name every person with a direct or indirect ownership or control interest of 5% or more, to disclose any owner convicted under section 1407 of the Human Services Code, and to report a change in a 5% interest "within 30 days"; an incomplete or inaccurate report is treated as a deceptive practice that justifies terminating the provider agreement. Changes of ownership have their own lane: when the IRS tax number stays the same, DHS wants a new Ownership and Controlling Interest form showing the post-transaction structure, one per tax ID; when the tax number changes, it wants a signed letter listing the old and new tax IDs and names, the effective date and a contact, plus a fresh enrollment application. Both go to RA-pwProvCHOW@pa.gov.

Since February 1, 2015 DHS returns incomplete applications rather than holding them (Quick Tip 175), and in the electronic era that return arrives as an email and a status of "Application Corrections Required" with the missing items written in the comments. The ClaimCarePro intake list for a Pennsylvania file, and how to send it securely, is on what we need from you to start credentialing.

A Pennsylvania group is enrolled as its own provider (physician groups fall under provider type 31 alongside individual physicians), and each clinician whose payments the group should receive files an Individual Request for Assignment of Fees. DHS calls these clinicians "Group Members (fee assigned practitioners)," and since February 24, 2023 an active group can log in to the PROMISe portal with its own credentials to reactivate, revalidate or change its members without starting from scratch (Quick Tip 266). To do so it needs each practitioner's program type, provider type, enrollment type, name, SSN and 13-digit PROMISe provider ID, and the feature disappears if the group itself is closed. A clinician who is new to Medical Assistance is still enrolled through New Application on the landing page before the group can attach them.

Two consequences for a new practice: the group's enrollment and each clinician's individual enrollment are separate applications with separate revalidation dates, and the location-level ID means a group that opens a second office enrolls that office for the group and for every rendering clinician who will see patients there. Our NPI Type 1 vs Type 2 page covers which NPI goes on which application.

Federal rules require every state Medicaid agency to screen applicants at a limited, moderate or high categorical risk level (42 CFR 455.450). Pennsylvania suspended its fee, fingerprint and site-visit requirements under a Section 1135 waiver in March 2020 and reinstated all of them by Medical Assistance Bulletin 99-22-11, issued December 29, 2022 and effective February 27, 2023. From that date a high-risk applicant completes fingerprint-based criminal background checks and a site visit, a moderate-risk applicant undergoes a site visit, and providers who were enrolled provisionally during the emergency without those steps were given 30 days' notice to complete them. The bulletin is explicit about the consequence: failure to submit fingerprints, a site visit that cannot verify the application (for example, a location that is not in operation), or a provider who does not cooperate with the visit "will result in closure of the provider service locations in PROMISe."

Which provider types are high risk is set out in Medical Assistance Bulletin 99-17-03 (March 6, 2017): home health agencies and private duty nursing (provider type 5), DME and medical supply providers, prosthetists, orthotists and opticians (type 25), DME vendors (type 55) and the attendant-care equivalents under provider type 59, plus any provider under a payment suspension for a credible allegation of fraud, who stays high risk for 10 years. High-risk providers and every person with a 5% or more direct or indirect ownership interest submit an FBI criminal background check and a Pennsylvania State Police Criminal Record Check, with fingerprints due within 30 days of a request. Individual physicians, therapists and behavioral health practitioners are not on the high-risk list; once enrolled, the listed types drop to moderate.

The application fee is the federal one in 42 CFR 455.460: institutional providers pay it at initial enrollment, revalidation and when adding a location, and individual physicians and non-physician practitioners are excluded. CMS sets the amount each calendar year; the Federal Register notice of December 3, 2025 puts it at $750 for applications submitted from January 1 through December 31, 2026, up from $730 in 2025. Pennsylvania's own rules (Quick Tip 195) add that the fee is paid through the electronic application, that DHS "will assess and collect one fee for multiple applications submitted by one provider in a 7-day time period" when you use the Initiate Additional Application feature, and that a hardship exception is uploaded with the application and decided by CMS, with DHS relaying the answer.

Pennsylvania publishes no day count for a fee-for-service enrollment decision, and we did not find one in the DHS pages, bulletins or quick tips read for this guide; the DHS enrollment page says only that the online portal "shortens review wait times" compared with paper. What DHS does publish, in Quick Tip 265, is how to watch the file. From the landing page choose Application Status, enter the ATN, the SSN or FEIN of the provider on the application and the password, and the summary returns the start date, the submission date and one of eight statuses: Incomplete, Submitted, Under Review, Corrections Required, Resubmitted, Expired, Approved or Denied. An approved application also displays the 13-digit provider ID, the effective date and the revalidation date, with a PDF of what was submitted.

Corrections. When enrollment staff send an application back, an email goes to the contact address entered when the application was started, the status changes to "Application Corrections Required," and the specific defects appear in a comment block both on the status page and at the top of the resumed application. An application that is not resubmitted with the requested information "in the allotted time" expires, DHS cannot process it, and the provider starts over.

By phone. The Medical Assistance Desk Reference routes provider enrollment to 1-800-537-8862, option 2, option 4, then option 1 to check the status of an application (including CHIP) or option 2 for any other enrollment question; Bulletin 99-22-11 gives the same path for fee, site-visit and background-check questions. Portal and login problems go to the Provider Assistance Center at 1-800-248-2152 or 717-975-4100, which the DHS PROMISe page staffs Monday through Friday starting at 8 a.m., with written questions to promise@pa.gov. National guidance on status checks is on our Medicaid provider enrollment hub.

Every Medical Assistance service location revalidates at least every 5 years, the floor set by 42 CFR 455.414 and repeated in the reminder box on every DHS bulletin: log into PROMISe, check the revalidation date of each location, and submit at least 60 days before it. Pennsylvania reinstated the requirement on June 1, 2021 under Medical Assistance Bulletin 99-21-01, and Quick Tip 255 describes the mechanics: DHS mails 90-day and 30-day revalidation notices to the mail-to and email addresses on the provider file, an application received before the due date keeps the location open while it is reviewed, and a missed due date "will result in closure of the provider service locations in PROMISe," after which only a reactivation application restores enrollment. A closed location is also a closed door at every HealthChoices plan, because the plans require an active PROMISe ID.

Two 2026 details matter for a multi-site practice. Quick Tip 281 (April 2026) says DHS expects "an anticipated increase in Provider Revalidation Applications later this year," asks providers to file early, and confirms that the portal's multiple-revalidation feature lets one application revalidate up to ten service locations; the portal landing page carried the same high-volume warning when we read it on October 29, 2026. Keep the addresses on the provider file current, because the notices go nowhere else. Plan recredentialing is a separate three-year cycle, covered below and on our recredentialing page.

HealthChoices is Pennsylvania's mandatory Medicaid managed care program, and the physical health side is organized into five zones, each with its own slate of plans (DHS Physical HealthChoices MCO page and the Statewide MCO Map, both read October 29, 2026). Which plans a practice needs depends on the counties its patients live in:

Three plans are statewide (Geisinger, Jefferson Health Plans EverWell and UPMC for You), AmeriHealth Caritas covers four zones, Highmark Wholecare two, and Keystone First and UnitedHealthcare appear only in the Southeast. A Philadelphia family practice therefore needs five contracts to see every HealthChoices patient who walks in; a Pittsburgh practice needs a different five; a Scranton practice needs four. DHS warns that state enrollment "does not guarantee enrollment in individual MCO networks" and that some networks are closed for network adequacy, which is why we ask each plan about panel status before filing, not after.

Behavioral health is carved out of the physical health plans. Each county (or county group) selects a Behavioral Health Managed Care Organization, and a counseling, psychiatry or substance-use practice credentials with that BH-MCO rather than with Keystone First or UPMC for You. The DHS Behavioral HealthChoices MCO page lists five as of October 29, 2026:

• Community Behavioral Health (CBH): Philadelphia.
• Community Care Behavioral Health Organization (CCBHO): 42 counties, including Allegheny, Berks, Chester, Delaware, Erie, Lackawanna, Luzerne, Lycoming, Monroe, Schuylkill and York.
• Magellan Behavioral Health of Pennsylvania: Bedford, Bucks, Cambria, Lehigh, Montgomery, Northampton, Somerset.
• PerformCare: Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon, Perry.
• Carelon Health of PA: Armstrong, Beaver, Butler, Crawford, Fayette, Indiana, Lawrence, Mercer, Venango, Washington, Westmoreland.

DHS's credentialing-standards page says each BH-MCO runs "its own process" for credentialing behavioral health providers, so there is no single statewide form. A practice in Montgomery County that offers both primary care and therapy ends up with Southeast physical health plans for one service line and Magellan for the other, each requiring the PROMISe ID first. We did not find a DHS-published credentialing timeline for any BH-MCO, so none is quoted.

The plans publish the steps, and they rhyme. Keystone First requires a signed participating provider agreement, participation in Medical Assistance with a valid PROMISe Provider Identification Number, and registration with CAQH; it conducts a site visit and medical record review at initial credentialing for PCPs and OB/GYNs, says the process "normally takes about 90 days," answers status questions at 1-800-521-6007, and recredentials every three years. Its CAQH page asks you to authorize Keystone First in CAQH and send the checklist and W-9 by fax to 1-877-759-6221 or secure email. AmeriHealth Caritas Pennsylvania runs credentialing (1-800-642-3510, option 2) and contracting (1-866-546-7972) in parallel, pulls the CAQH profile once you authorize it, warns that CAQH data must match your billing information or claims will deny later, and promises written notice within 60 calendar days of the credentialing committee's decision, with a 30-day appeal window. Both plans want the PROMISe ID in hand before they begin.

Behind those policies is state law. 28 Pa. Code 9.761 requires every managed care plan to keep a credentialing system with written policies for initial credentialing, recredentialing "at least every 3 years," restrictions, terminations and denial notices that carry "a clear rationale for the decision," to disclose its credentialing criteria and procedures to a provider on written request, and to report its approvals and rejections to the Department of Health every two years. 40 P.S. 991.2121 puts the same disclosure and written-notice duties in statute and bars a plan from excluding a provider for having many high-cost patients or for a moral or religious objection to a service. Neither sets a deadline in days for a credentialing decision, and we found no enacted Pennsylvania statute that does, so the 90-day figure above is a plan's own estimate, not a legal limit. More on the profile itself: CAQH explained; the national plans' steps are on our payer-by-payer credentialing hub.

Pennsylvania's Medicare Administrative Contractor is Novitas Solutions under Jurisdiction L, which Novitas's JL home page describes as serving "Providers in DC, DE, MD, NJ & PA." Novitas also holds Jurisdiction H (Texas, Colorado, Arkansas, Oklahoma and others), and its JH customer line is a different number, so a Pennsylvania practice that copies a phone number from a Texas or Colorado guide reaches the wrong queue. The Novitas Inquiry Guide for JL (last modified June 8, 2026) routes "Medicare Part A/B enrollment forms, status of your forms, revalidation efforts" to 1-877-235-8073, option 3. We did not read a page stating the JL line's hours, so none are given here.

You file the CMS-855I or CMS-855B in PECOS and Novitas works it against the CMS timeliness standard (online with no site visit or development: 95% within 15 calendar days and all within 50). Under 42 CFR 424.521 physicians and non-physician practitioners may bill for up to 30 days before the effective date when circumstances prevented earlier enrollment. Forms, PECOS and timelines are on our Medicare provider enrollment page.

Railroad Retirement Board beneficiaries' Part B claims go to Palmetto GBA rather than Novitas. After Novitas approves Part B enrollment, request a Railroad Medicare PTAN in Palmetto's PTAN Lookup and Request Tool; Palmetto builds it from the Medicare record and asks you to allow up to 30 days. For the same Novitas enrollment pipeline in Jurisdiction H, see provider credentialing in Texas and provider credentialing in Colorado; Pennsylvania's eastern neighbor under a different contractor is covered in provider credentialing in New York.

In our experience the file, not the agency, is where Pennsylvania applications lose weeks, and the location-level design multiplies small errors. What we check before a PROMISe application is submitted:

• A location that was never enrolled. The clinician has a PROMISe ID from a prior employer, the new office does not, and every claim from the new address denies on the NPI-taxonomy-ZIP match.
• A ZIP+4 or taxonomy that differs between NPPES and PROMISe. The claim match uses the nine-digit ZIP and the taxonomy on the claim; a five-digit ZIP in one system and a different taxonomy in the other is a denial.
• Ownership disclosure that stops at the practice name. Every 5% direct or indirect owner, and the managing employee for each location, has to be on the form, and a change has to be reported within 30 days.
• An unmonitored contact email. Corrections requests, approvals and the 90-day and 30-day revalidation notices all go to the addresses on the application and the provider file; an expired application cannot be revived.
• A group application without the fee-assignment paperwork. Payments route to the group only when each clinician's Individual Request for Assignment of Fees is on file.
• Applying to the plan before the PROMISe ID exists. Keystone First and AmeriHealth Caritas will not credential without it, and a closed network is only discovered by asking.
• CAQH that disagrees with the W-9 or the billing address. AmeriHealth Caritas says mismatched CAQH data delays credentialing and denies claims later.
• Treating the five zones as one state. A practice near a zone line (Centre County is Northeast; Blair, next door, is Southwest) can need plans from both.

Our process is built around those failure points: one checked file compared field by field across PROMISe, NPPES, PALS, the IRS letter and CAQH before anything is signed, then follow-up with every payer each week, with the representative's name, the date and the reference number logged.

Have these ready and current: the individual NPI and, for any group, the Type 2 NPI (with NPPES addresses and taxonomies matching each office); the IRS letter showing the legal name and FEIN; the Pennsylvania Department of State license for each clinician; DEA and, where labs are billed, the CLIA certificate and the Pennsylvania clinical laboratory permit; board certification if held; malpractice coverage; the names, SSNs and percentages of every 5%-or-more owner and the managing employee at each location; every service address with its ZIP+4; a current CAQH profile authorized for the plans you intend to join; and the Novitas approval letter once Medicare is done.

If you are unsure which of these steps actually lets you bill, our explainer on what provider credentialing is separates enrollment, credentialing and contracting. The same process in other states: provider credentialing in Florida and provider credentialing in Kentucky.

ClaimCarePro enrolls providers and every service location with Pennsylvania Medical Assistance in PROMISe and carries the file through credentialing with the HealthChoices plans in your zone, the county BH-MCO where behavioral health is involved, Novitas Medicare, the Railroad Medicare PTAN, revalidation and the commercial plans, with weekly logged follow-up on every payer. Pennsylvania files are billed at our published flat prices: $250 per payer application per provider, CAQH setup $250, re-credentialing $250, maintenance $99 per provider per year, or the new-practice bundle at $1,750 per provider ($1,400 each additional provider on the same group and payers). Start credentialing now for a secure start link within one business hour, or call (844) 772-8902. What is included is on our provider credentialing services page.

Updated October 29, 2026. All sources were read on October 29, 2026 unless noted. When DHS, a plan or a contractor changes a published rule, its own page controls over this article. Nothing here is legal advice.

• Pennsylvania DHS, PROMISe Provider Enrollment (eligibility, online portal, MCO caveat, background checks, change of ownership, forms): pa.gov
• Pennsylvania DHS, PROMISe (Provider Assistance Center 1-800-248-2152, Provider Enrollment 1-800-537-8862, promise@pa.gov, hours): pa.gov
• PROMISe Provider Portal landing page (New Application, Reactivation, Resume Application, Application Status; ATN rule; application fee; primary-source license verification; NLC nurses; 2026 revalidation-volume notice): promise.dhs.pa.gov
• Pennsylvania DHS, Provider Enrollment Documents (provider types and requirements sheets; paper applications by phone): pa.gov; Provider Type 31 Physician requirements (May 19, 2021): pa.gov
• Pennsylvania DHS, Medical Assistance Desk Reference (provider enrollment phone tree): pa.gov
• Medical Assistance Bulletin 99-22-11, Reinstatement of Provider Enrollment Requirements (issued December 29, 2022, effective February 27, 2023), read from the copy hosted by Aetna Better Health of Pennsylvania because the dhs.pa.gov link now redirects: aetnabetterhealth.com
• Medical Assistance Bulletin 99-17-03, Implementation of Criminal Background Checks for Providers Assigned ACA Categorical Risk Level of High (March 6, 2017): pa.gov
• Provider Quick Tips: 265, application status and corrections (January 2023): pa.gov; 255, revalidation requirements (March 2021): pa.gov; 281, streamline your revalidation submission (April 2026): pa.gov; 219, service location enrollment deadline: pa.gov; 173, enroll and update all service locations: pa.gov; 195, application fee (June 2016): pa.gov; 266, group access for fee-assigned practitioners (February 2023): pa.gov; 175, incomplete applications returned (December 2014): pa.gov
• 55 Pa. Code 1101.42, Prerequisites for participation: pacodeandbulletin.gov; 55 Pa. Code 1101.43, Enrollment and ownership reporting requirements: pacodeandbulletin.gov
• Pennsylvania DHS, Physical HealthChoices Managed Care Organizations: pa.gov; Statewide MCO Map (zones and counties): pa.gov
• Pennsylvania DHS, Behavioral HealthChoices MCOs by county: pa.gov
• AmeriHealth Caritas Pennsylvania, Credentialing: amerihealthcaritaspa.com
• Keystone First, FAQ about becoming a participating provider: keystonefirstpa.com; CAQH Credentialing: keystonefirstpa.com
• UPMC Health Plan, Complete reinstated PROMISe ID enrollment requirements to avoid claim denials (July 27, 2023): upmchealthplan.com
• 28 Pa. Code 9.761, Provider credentialing: law.cornell.edu; 40 P.S. 991.2121, Credentialing: codes.findlaw.com
• Federal Register, December 3, 2025, CY 2026 application fee for institutional providers: govinfo.gov
• Novitas Solutions, Medicare JL home (states served): novitas-solutions.com; Novitas Inquiry Guide for Jurisdiction L providers (last modified June 8, 2026): novitas-solutions.com
• Pennsylvania State Board of Medicine, Resources and Documents (PALS, verification policy): pa.gov; Pennsylvania Licensing System: pals.pa.gov
• CMS, Medicare Program Integrity Manual, chapter 10 (read October 23, 2026 for our Medicare enrollment page): cms.gov
• 42 CFR 424.521 (read October 23, 2026 for our Medicare enrollment page): ecfr.gov; 42 CFR 455.450: ecfr.gov; 42 CFR 455.460: ecfr.gov
• Palmetto GBA, Enroll in Railroad Medicare (published January 13, 2026; read October 23, 2026 for our Medicare enrollment page): palmettogba.com

Not found, and so not stated: a Pennsylvania processing standard in days for new fee-for-service applications, the full text of Medical Assistance Bulletins 01-16-14, 99-21-01 and 99-16-13 (the dhs.pa.gov PDFs now redirect to a search page), the Electronic Provider Enrollment User Manual, the Insurance Department's provisional-credentialing advisory, Novitas JL phone hours, the Jefferson Health Plans, UPMC for You, Highmark Wholecare and Geisinger join-network pages, published credentialing timelines from the BH-MCOs, and the Community HealthChoices plan list.