FAQ: Enrollment, Provider File
1. How do I enroll in the Pennsylvania Medical Assistance Program and what are the requirements for enrollment?
Enrollment information, including a link to the Online Provider Enrollment application and requirements, as well as the Electronic Provider Enrollment User Manual, can be found on the Provider Enrollment Information Page of the Department of Human Services (DHS) website: https://www.dhs.pa.gov/providers/Providers/Pages/PROMISe-Enrollment.aspx
2. How do I revalidate an existing service location?
Providers must first logon to the PROMISeTM Provider Portal here: (https://promise.dpw.state.pa.us/) to access the Electronic Revalidation Application, which is available from the "My Home" page in the Provider Services section on the left.
3. How do I enroll a new service location for an existing provider?
Providers must first logon to the PROMISeTM Provider Portal here: (https://promise.dpw.state.pa.us/) to access the Electronic Provider Enrollment Application for a new service location, which is available from the "My Home" page in the Provider Services section on the left.
4. How do I reactivate a closed service location?
Providers closed for 2 years or less must first logon to the PROMISeTM Provider Portal here: (https://promise.dpw.state.pa.us/) to access the Electronic Reactivation Application, which is available from the "My Home" page in the Provider Services section on the left. Providers closed for more than 2 years can access the revalidation application from the portal home page without logging in.
5. How do I make a change to an existing service location?
Providers must first logon to the PROMISeTM Provider Portal here: (https://promise.dpw.state.pa.us/) to access the Electronic Change Request Application, which is available from the "My Home" Page in the Provider Services section on the left.
6. How do I terminate enrollment?
Providers must first logon to the PROMISeTM Provider Portal here: (https://promise.dpw.state.pa.us/) to terminate their enrollment in Medical Assistance. The "Terminate Enrollment" link is available from the 'My Home" page in the Provider Services section on the left.
7. How do I access my "Provider Enrollment Summary", which includes my current enrollment information in PROMISeTM ?
Providers must first logon to the PROMISeTM Provider Portal here: (https://promise.dpw.state.pa.us/) to access their Enrollment Summary, which also includes the following information:
- Active Service Locations: Users may download an extract of all active service locations associated with their 9-digit provider ID which includes the following fields: 13-digit provider ID, NPI, revalidation date, provider type, name, address, specialties, and taxonomy codes.
- Fee Assignments: Group providers may also download an extract of all providers associated with the group service location within the last 2 years. Fields include: group provider ID, individual provider ID, NPI, revalidation date, provider type, fee assignment effective date, fee assignment end date, name, and address.
8. What is the difference between an individual and 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.
9. How can I speak to an enrollment representative?
You may contact Provider Enrollment by calling 1-800-537-8862. Follow the prompts to reach an enrollment representative. Hours of Operation are Monday through Friday, 8:00 A.M. - 4:30 P.M.