How to Enroll as a Pennsylvania Medical Assistance Provider

You can enroll as a Pennsylvania medical assistance provider in several ways. The quickest and easiest method is online through the PA Provider Enrollment Portal.

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Introduction

In order to provide health care services to Medical Assistance recipients, you must first enroll as a provider with the Pennsylvania Department of Human Services (DHS). This guide provides the steps you need to follow in order to complete the enrollment process.

What is Medical Assistance?

Medical Assistance also known as Medicaid, is a state and federal program that helps with medical costs for low-income families and individuals. In Pennsylvania, the Department of Human Services (DHS) runs the Medical assistance program.

If you are interested in becoming a Medical Assistance provider, there are a few things you need to know. First, you must be enrolled in the Pennsylvania Provider Enrollment System (PAPERS). This is an online system that providers use to apply for Medicaid enrollment.

Second, you must have a National Provider Identifier (NPI). An NPI is a unique 10-digit number assigned to health care providers by the Centers for Medicare and Medicaid Services (CMS). You can apply for an NPI through the CMS National Plan & Provider Enumeration System (NPPES).

Third, you will need to submit proof of your professional license(s) to DHS. You can do this by faxing or mailing a copy of your license(s) to DHS. Once DHS has received and processed your information, you will be notified of your Medicaid provider number.

Enrolling in Medicaid as a provider is simple and straightforward. By following these steps, you can become a Medicaid provider in Pennsylvania and help those who need it most.

Who is eligible for Medical Assistance?

In order to be eligible for Medical Assistance you must:
-Be a resident of Pennsylvania
-Be a U.S. citizen or have legal immigration status
-Have an income at or below the program’s limit (this varies depending on your family size)
-Not have assets above a certain amount (this varies depending on your family size)
-Meet additional requirements if you are pregnant, under age 21, over age 65, or have a disability

How to Enroll as a Pennsylvania Medical Assistance Provider

In order to enroll as a Pennsylvania Medical Assistance provider, you must complete an application and submit it to the Pennsylvania Department of Health. The application must be accompanied by a $50 non-refundable processing fee. You will also need to have your fingerprints taken and submit them to the department.

Before you begin the enrollment process, make sure you have the following information:
-Your federal tax identification number
-Your social security number
-A copy of your certificate of liability insurance

Once you have gathered all of the necessary information, you can begin the enrollment process by following these steps:
1. Go to https://www.medicalassistant.net/pa/enroll/ and click on the “Start Enrollment” button.
2. Enter your federal tax identification number and click “Next”.
3. Enter your social security number and click “Next”.
4. Select the type of provider you are enrolling as and click “Next”.
5. Read the instructions on how to complete the fingerprinting process and click “Next” when you are ready to proceed.
6. Review the information on liability insurance requirements and click “Next” when you are ready to proceed.
7. Review the provider enrollment agreement information and click “I Agree” if you agree to the terms and conditions outlined in the agreement

What type of providers can enroll in Medical Assistance?

There are three types of providers who can enroll in Medical Assistance:
-Individual/Sole Proprietor
-Group Practice
-Facility/Institution

To enroll as a provider, you must first complete and submit an application. The application can be found on the Pennsylvania Department of Human Services website. After your application has been submitted, you will be contacted by a representative from the Medical Assistance program to discuss the next steps in the enrollment process.

How to maintain your enrollment in Medical Assistance

Maintaining your enrollment as a Pennsylvania Medical Assistance provider is important to ensure you can continue seeing Medical Assistance patients. To maintain your enrollment, you must complete the following steps on a yearly basis:

1. Complete the required training
2. Renew your PA Provider enrollment
3. Complete the revalidation process

If you do not complete these steps, your enrollment will be canceled and you will no longer be able to see Medical Assistance patients.

How to report changes to your enrollment information

It is important that you keep your enrollment information up-to-date. You must report any changes to your name, address, telephone number, e-mail address, National Provider Identifier (NPI), Tax Identification Number (TIN), specialties, group affiliation or provider type within 30 days. You can report these changes:

-In writing to: Provider Enrollment Division, Medical Assistanceprograms, PO Box 2675, Harrisburg PA 17105-2675
-By fax to: Attn: Provider Enrollment 717-772-4376
-By email to: RA- [email protected]
-Through the PROMISe™ provider portal

How to appeal a decision made about your enrollment

You may appeal any decision made about your enrollment, including decisions about your eligibility or the type of medical assistance you will receive.

To appeal a decision, you must first ask for a fair hearing. A fair hearing is a meeting where you can explain your side of the story and why you think the medical assistance office made the wrong decision.

You have the right to have an attorney represent you at the fair hearing. You also have the right to have someone else represent you, such as a family member or friend.

If you do not agree with the result of the fair hearing, you may appeal that decision to Pennsylvania’s Office of Administrative Hearings.

Frequently Asked Questions

-How do I enroll as a Pennsylvania medical assistance provider?
-What are the requirements for enrollment?
-What is the process for enrolling?
-How long does it take to be approved?
-What are the benefits of enrolling?

Resources

In order to enroll as a Pennsylvania medical assistance provider, you will need to complete the following steps:

1.Register with the Commonwealth of Pennsylvania’s Department of State by completing and submitting a Business Entity Report. This can be done online, by mail, or in person.
2. Obtain a Employer Identification Number (EIN) from the Internal Revenue Service.
3. Complete the Pennsylvania Medical Assistance Provider Enrollment Application and submit it along with the required documentation to the address listed on the form.
4. Once your enrollment has been processed, you will receive a Provider Participation Agreement and a welcome packet in the mail.