Medicaid Provider Enrollment in Pennsylvania

Regulatory Agency

Pennsylvania Department of Human Services, Office of Medical Assistance Programs

Key Requirements

• Complete the Medicaid provider enrollment application through Pennsylvania Department of Human Services, Office of Medical Assistance Programs
• Obtain a National Provider Identifier (NPI) from CMS
• Pass a state background check and fingerprinting for all owners/operators
• Provide proof of current state licensure for your provider type
• Submit a signed Medicaid Provider Agreement
• Complete required provider screening and enrollment verification
• Maintain general liability and professional liability insurance
• Comply with all federal and state Medicaid regulations

Fees

Application fees vary; contact your state Medicaid agency for current fee schedule

Tips

Start by obtaining your NPI number through NPPES (nppes.cms.hhs.gov). Then contact Pennsylvania Department of Human Services, Office of Medical Assistance Programs for the specific enrollment forms for your provider type. Many states now offer online enrollment portals.

Key Regulations

Federal requirements under 42 CFR Part 455 govern Medicaid provider enrollment. Pennsylvania implements additional state-specific requirements. All providers must comply with the False Claims Act and Anti-Kickback Statute.