Active Providers or Providers Closed for Less Than 2 Years
Providers must logon to the portal to initiate an application if they are active or have been closed for less than 2 years.
New Providers or Providers Closed for More Than 2 Years
To enroll, providers can complete an on-line provider enrollment application and supply any required supporting documentation. This includes providers who are not billing PA Medicaid or CHIP but provide services to beneficiaries. All applications will be screened based on Federal and State guidelines prior to an enrollment decision. Please retain copies of your application materials for your records. You will receive a response upon approval or denial of your enrollment with PA Medicaid and/or CHIP.
Types of Provider Enrollment Applications
There are two types of enrollment applications and each requires a provider to complete an entire application. Please click the appropriate navigation item on the left-hand side of the Home page to start a "New Application" or "Reactivation".
Tracking Provider Enrollment Applications
A unique number called the "Application Tracking Number" (ATN) will be assigned when a "New Application" or "Reactivation" is started. Prior to exiting the application, write down this number and keep it for your records. If you need to access the application later, please click the appropriate navigation item on the left-hand side of the page to "Resume Application" or to check the "Application Status". Note: Information will not be retained and the application will be deleted if the provider does not complete the application, supply the required supporting documentation and click the "Submit Application" button on the "Summary" page when finished.
Have a Question?
If you have any questions about completing an application, please refer to the Quick Links under Enrollment Information and call the appropriate toll-free number for your provider type.