FAQ: Enrollment, Provider File
1. How do I enroll in the Pennsylvania Medical Assistance Program and what are the requirements for enrollment?
You may find provider enrollment information (including applications and requirements) in the Provider Enrollment Information section of the Office of Medical Assistance website.
2. How do I make changes to or close service locations or open new service locations?
Old or inactive service locations, mail-to, or pay-to addresses can be end-dated using the PROMISe™ Service Location Change Request Form. You may also use this form to change pay-to or mail-to only addresses to already existing service locations. A provider will need to make sure that the new Service Location Code is used for the appropriate billing purposes.
Providers may elect to use the ePEAP system to update their provider file. Once registered, you can change your pay-to, mail-to, and home office addresses for any of your existing service locations on-line. You cannot add a new service location or change the service location address through e-PEAP. Both of these actions require an enrollment application.
To open a new service location; a provider will need to use the same type of application used for their initial enrollment.
3. How can I speak to an enrollment representative?
You can contact Provider Enrollment Unit by calling 1-800-537-8862. Select menu option #1 and follow the prompts to reach an enrollment representative. Hours of Operation are Monday through Friday, 8:00 a.m.-4:30 p.m.
Remember, you may find provider enrollment information (including applications) in the Provider Enrollment Information section of the Department of Human Services website.
4. What is the difference between an individual and a group practice?
An individual is a sole practitioner who is enrolled under his or her own social security number or IRS (if incorporated as an individual). The individual may or may not be associated with a group practice or group practices.
Group practices are professional corporations or partnerships composed of individual practitioners of the same provider type. Group enrollments were created to permit individually enrolled practitioners to assign their fees to group practices with which they are associated.
The group practice must be enrolled as a group provider, but may not bill for services as a rendering provider. When invoicing for payment, the MA number of the individual practitioner who performs the service must be identified as the rendering provider. The group number is used to identify the entity to which the payment will be made/assigned.
5. If PROMISe™ provider numbers are incorrect and ePEAP has not been of assistance, who can I call to verify the ID numbers?
If you have questions regarding your provider numbers, please call 1-800-537-8862, select menu option #1, and follow the prompts to reach an enrollment representative.
6. If we were issued a PROMISe™ provider number for service locations where we will never render services (such as Post Office boxes), what should we do?
All address codes in MAMIS were converted to service locations in PROMISe™. If you have a service location that is not truly a location where services are provided, it can be closed through an ePEAP update at the PROMISe™ website promise.DHS.state.pa.us, or by completing and mailing the PROMISe™ Service Location Change Request Form.