Pennsylvania Medicaid
Complete guide to Pennsylvania Medical Assistance enrollment, managed care, and provider requirements
Enrollment Time
60-90 Days
MCOs
9 Plans
Timely Filing
180 Days
Model
Managed Care
Pennsylvania Medical Assistance Overview
Pennsylvania's Medical Assistance (MA) program serves over 3 million beneficiaries through a combination of managed care plans and fee-for-service. The state uses HealthChoices managed care in most counties.
Key Pennsylvania Features:
- • HealthChoices: PA's mandatory managed care program
- • Regional Plans: Different MCOs serve different zones (Southeast, Southwest, Central, etc.)
- • Community HealthChoices (CHC): Long-term services and supports
- • Separate BH Carve-Out: PerformCare manages behavioral health separately
Provider Enrollment Process
Step-by-Step PA Medical Assistance Enrollment
1. Enroll with PA Department of Human Services
Complete enrollment with the Pennsylvania Department of Human Services:
- • Submit PROMISe™ provider enrollment application online
- • Provide PA license, NPI, TIN, and supporting documentation
- • Complete required attestations and disclosures
- • Processing time: 45-75 days
2. Contract with HealthChoices Plans
After DHS enrollment, credential with MCOs in your region:
- • Identify which plans operate in your county/zone
- • Submit credentialing applications (most use CAQH)
- • Each plan has separate provider agreements
- • Processing time: 60-90 days per plan
Total Timeline
- • DHS enrollment: 45-75 days
- • MCO credentialing: 60-90 days per plan
- • Total: 105-165 days from start to billing
Pennsylvania HealthChoices Plans
Note: Pennsylvania is divided into zones. Not all plans operate in all regions. Check which plans serve your county.
AmeriHealth Caritas
Geisinger Health Plan
Gateway Health Plan
Keystone First (AmeriHealth)
PA Health & Wellness (Centene)
UPMC For You
United Healthcare Community Plan
Aetna Better Health of Pennsylvania
PerformCare (Behavioral Health)
Regional breakdown: Southeast PA (Philadelphia area) - AmeriHealth/Keystone First dominate. Western PA - UPMC and Gateway strong. Central PA - Geisinger dominant. Contract with 2-3 plans in your region.
Behavioral Health Services
PA Medicaid Behavioral Health Coverage
Pennsylvania has a separate behavioral health managed care system through PerformCare, which manages BH services statewide.
Important: Separate BH Credentialing
Behavioral health providers must credential separately with PerformCare in addition to DHS enrollment and physical health MCOs.
Contact: 1-888-722-8646 (PerformCare Provider Services)
Covered BH Services
- • Outpatient therapy (individual, group, family)
- • Psychiatric evaluation and medication management
- • Intensive outpatient programs (IOP)
- • Partial hospitalization programs (PHP)
- • Residential treatment facilities
- • SUD treatment (all levels of care)
- • Peer support services
- • Crisis intervention
Important Contacts
PA Department of Human Services
PerformCare (Behavioral Health)
Provider Services
1-888-722-8646
PerformCare Website
PerformCare.org