​CHIP Provider Enrollment Information

The Department of Human Services (Department) is implementing the Affordable Care Act (ACA) Provider Screening and Enrollment provisions which require all providers who render services to CHIP enrollees to be enrolled with the Department of Human Services. To enroll, providers must complete an enrollment application appropriate for their provider type and submit all required documents. If a provider is already enrolled in the Pennsylvania Medical Assistance program, the provider does not need to enroll again in CHIP.

Criminal Background Check

The Department of Human Services has assigned certain provider types and specialties to the "high" categorical risk level. The Affordable Care Act (ACA) requires all providers deemed to be a high categorical risk level to obtain criminal background checks, which include a Federal Bureau of Investigation (FBI) criminal background check and a Pennsylvania State Police Criminal Record Check. Any person with a 5 percent or greater direct or indirect ownership interest in the high risk provider must also submit criminal background check information. For more information, please see Medical Assistance Bulletin 99-17-03.

Please do not register through either of the below links unless you have been notified by the Department that you, or the Provider you own, are classified as a High Risk provider and must be fingerprinted. Applicants seeking Child Abuse Clearances for purposes of employment, due to working with children, for example, should NOT use the below links.

If you are an individual provider who has been placed in the "high" categorical risk level, please visit the IdentoGo website and follow the instructions provided for obtaining a fingerprint-based criminal background check.

If you are the owner of a provider that has been placed in the "high" categorical risk level, please visit the IdentoGo website and follow the instructions provided for obtaining a fingerprint-based criminal background check.

Please note that if the banner at the top of the screen does not read OMAP – Medical Assistance Provider Direct/Indirect Ownership Interest or OMAP – Medical Assistance Provider, your background check information will be sent to the wrong office and you will have to re-register.

Once registered, you will be assigned a registration code. Please enter that code and the date of your screening into the Electronic Provider Portal application.

To obtain a Pennsylvania State Police Criminal Record Check, visit the Pennsylvania State Police Criminal Record Check website. The department will request the results of the State Police Criminal Record Check from the provider and any person with a 5 percent or greater ownership interest in the provider. Please retain and submit these results directly to the Department.
 

Enroll Electronically 

 » ELECTRONIC PROVIDER ENROLLMENT APPLICATION

CHIP Providers are now able to enroll through the electronic provider enrollment application. The benefits of using the secure online portal are:

• Allowing documents, that previously had to be mailed or faxed, to be uploaded directly to the portal
• Permitting providers see the status of their submission
• Decreasing wait time to review applications
• Electronic Enrollment Application User Interface (UI) Training for CHIP Providers 

ENROLL ON PAPER

The table below contains links to applicable provider enrollment forms for each provider type. Print the documents for your provider type and follow the instructions for completing the documents. Please check if the provider type has additional requirements that must be included with the application. Click here for a list of provider types and specialties for CHIP providers/CHIP Provider Crosswalk.
 

All enrollment documents are in Adobe PDF format. You must have a copy of Adobe Acrobat Reader installed on your system to view them. 

For questions, please call Provider Enrollment at 1-800-537-8862 and select option 3, then option 1, option 1 and option 4.