promise.dpw.state.pa.us
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205.132.23.131
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Submitted URL: https://promise.dpw.state.pa.us/
Effective URL: https://promise.dpw.state.pa.us/portal/provider/Home/tabid/135/Default.aspx
Submission: On August 20 via manual from US — Scanned from US
Effective URL: https://promise.dpw.state.pa.us/portal/provider/Home/tabid/135/Default.aspx
Submission: On August 20 via manual from US — Scanned from US
Form analysis 1 forms found in the DOM
POST /portal/provider/Home/tabid/135/Default.aspx
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<a href="http://promise.dpw.state.pa.us/promisehelp/manuals/PROMISeProviderInternetUserManual.pdf" target="_blank">
<span style="font-size:x-small">Internet Help Manual</span>
</a>
<br>
<br>
<span style="font-size:x-small">Enrollment Information:</span>
<br>
<ul>
<li>
<a href="https://www.dhs.pa.gov/providers/Providers/Pages/PROMISe-Enrollment.aspx" target="_blank"><span style="font-size:x-small">Medical Assistance (MA)</span></a>
</li>
<li>
<a href="https://www.dhs.pa.gov/providers/Providers/Pages/PROMISE-Chip-Enrollment.aspx" target="_blank"><span style="font-size:x-small">Children's Health Insurance Program (CHIP)</span></a>
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<br>
<a href="https://www.dhs.pa.gov/docs/Publications/Pages/default.aspx" target="_blank">
<span style="font-size:x-small">HealthChoices Expansion Provider Training Guides</span>
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<br>
<br>
<a href="http://www.dhs.pa.gov/" target="_blank">
<span style="font-size:x-small">Department of Human Services</span>
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<label id="dnn_ctr1225_BroadcastMessage_messageRepeater_messageHCPLabel_0">Effective 6/28/24, when changes are made to a bank account and/or routing number, and verified, the Electronic Funds Transfer (EFT)
will stop. Up to three physical paper checks will be mailed to the last reported payment address, after which, EFT will resume.</label>
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<div class="CellLeft">
<p class="Row">
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<div style="font-family: Tahoma;" class="text-justify-not-xs text-justify-not-sm">
<p class="normal">The Commonwealth of Pennsylvania Department of Human Services offers state of the art technology with PROMISe™, the claims processing, provider enrollment, and user management information
system. Please take advantage of online training to use the system to its full advantage. </p>
<span style="font-size:12pt; font-family:Tahoma;">Medical Assistance (MA) and Children's Health Insurance Program (CHIP) On-line Provider Enrollment Application </span><br><br>
<p class="normal"> In order for providers to participate with the Department of Human Services, they must first enroll. To be eligible to enroll, practitioners in Pennsylvania must be licensed and currently
registered by the appropriate state agency. Out-of-state practitioners must be licensed and currently registered by the appropriate agency in their state and they must provide documentation that they
participate in that state’s Medicaid and/or CHIP program. Other providers must be approved, licensed, issued a permit, certified by the appropriate state agency, or if applicable certified under Medicare. </p>
<p class="normal"> 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. </p>
<p class="normal">
<span style="font-style:italic; font-weight:bold;">New Providers or Providers Closed for More Than 2 Years</span><br>
<span>Select one of the provider enrollment links to the left to start an application, resume an existing application, or to check the status of an application. </span>
</p>
<p class="normal">
<span style="font-style:italic; font-weight:bold;">Active Providers or Providers Closed for Less Than 2 Years</span><br>
<span>Providers must logon to the portal to initiate an application if they are active or have been closed for less than 2 years. </span>
</p>
<p class="normal">
<span style="font-style:italic; font-weight:bold;">Provider Application Fee</span><br>
<span>The Affordable Care Act requires states to collect an application fee, if applicable, prior to executing a provider agreement from a prospective or re-enrolling provider. Refer to 42 CFR 455, Subpart E –
Provider Screening and Enrollment, Section 455.460 for the complete regulation. The Centers for Medicare & Medicaid Services (CMS) sets the amount of the application fee every year. </span>
</p>
<p class="normal"> Providers may request a hardship exception to the application fee requirement. If an exception is requested, the provider will be prompted to submit (upload) documentation. CMS will determine
whether or not to grant the hardship exception and communicate the information back to the department. The department will notify the provider of the CMS’ decision. </p>
<p class="normal"> To pay an application fee, providers must enroll and revalidate through the Electronic Provider Enrollment Application. </p>
<p class="normal"> The department will assess and collect one fee for multiple applications submitted by one provider in a 7 day time period. Providers who wish to submit multiple applications (for multiple
service locations) and pay one fee should use the "Initiate Additional Application" feature and submit all applications within 7 days. </p>
<p class="normal"> For more information about the application fee, please see the
<a href="https://www.dhs.pa.gov/docs/Publications/Documents/FORMS%20AND%20PUBS%20OMAP/c_228992.pdf" target="_blank">ACA Enrollment Application Fee </a>Medical Assistance Bulletin. For CHIP providers, please
contact your designated CHIP Managed Care Organization(s). </p>
<p class="normal">
<span style="font-style:italic; font-weight:bold;">Fingerprint-based Criminal Background Checks</span><br>
<span>Providers assigned to the "high" categorical risk level are required by the Affordable Care Act to obtain fingerprint-based criminal background checks, which include a Federal Bureau of Investigation
(FBI) criminal background check and a Pennsylvania State Police Criminal Record Check. In addition, any person with a 5% or more direct or indirect ownership interest in the "high" risk provider must also
submit fingerprint-based background checks. Refer to 42 CFR 455, Subpart E – Provider Screening and Enrollment, Section 455.434 for detail on the regulation.</span>
</p>
<p class="normal"> For more information about the Fingerprint-based Criminal Background Checks and criteria used to assign a provider to the "high" categorical risk level, please see the
<a href="https://www.dhs.pa.gov/docs/Publications/Documents/FORMS%20AND%20PUBS%20OMAP/c_259400.pdf" target="_blank">Implementation of Fingerprint-based Criminal Background Checks for Providers Assigned ACA Categorical Risk Level of High </a>Medical
Assistance Bulletin. For CHIP providers, please contact your designated CHIP Managed Care Organization(s). </p>
<p class="normal">
<span style="font-style:italic; font-weight:bold;">Tracking Provider Enrollment Applications</span><br>
<span>A unique number called the "Application Tracking Number" (ATN) will be assigned when a "New Application", "Revalidation" 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 "<span
style="text-decoration:underline;font-weight:bold;">Resume Application</span>" or to check the "<span style="text-decoration:underline;font-weight:bold;">Application Status</span>". <span
style="font-weight:bold;">Note</span>: 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.</span>
</p>
<span class="normal"> If you have any questions about completing an application, please refer to "Contact Information" and call the appropriate toll free number for your provider type. </span>
<p></p>
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<!-- Intro --> The way you sign into the the PROMISe™ Portal provides a better safeguard to the privacy and security of your healthcare information. You may have signed into other web sites by using a User ID and Password. The PROMISe™
Portal also uses your site key token. Here is how the service works: <ol>
<li> Type your User ID and click <b>Log In</b>. </li>
<li> Your site key token displays. If you recognize your site key token, you know you can safely type your password. If you do not recognize your site key token, do not type your password. </li>
<li> Your personalized site key token helps you identify that you are at the valid PROMISe™ Portal site. </li>
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<b>Note:</b> If you have not created your personalized site key token, you will be asked to do so before you sign into the PROMISe™ Portal.
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</form>Text Content
Login
Home
Home
Tuesday 08/20/2024 03:40 PM EST
Provider Login
*User ID
User ID is a required field.
Forgot User ID?
Register Now
Where do I enter my password?
Provider Enrollment
New Application
Reactivation
Resume Application
Application Status
Quick Links
Internet Help Manual
Enrollment Information:
* Medical Assistance (MA)
* Children's Health Insurance Program (CHIP)
* DHS Provider Enrollment Listserv
This is the mechanism for receiving email updates regarding provider
enrollment enhancements.
* DHS Listservs
There are additional topics for which providers can sign up to receive email
updates from DHS.
HealthChoices Expansion Provider Training Guides
Department of Human Services
Broadcast Messages
Effective 6/28/24, when changes are made to a bank account and/or routing
number, and verified, the Electronic Funds Transfer (EFT) will stop. Up to three
physical paper checks will be mailed to the last reported payment address, after
which, EFT will resume.
The Commonwealth of Pennsylvania Department of Human Services offers state of
the art technology with PROMISe™, the claims processing, provider enrollment,
and user management information system. Please take advantage of online training
to use the system to its full advantage.
Medical Assistance (MA) and Children's Health Insurance Program (CHIP) On-line
Provider Enrollment Application
In order for providers to participate with the Department of Human Services,
they must first enroll. To be eligible to enroll, practitioners in Pennsylvania
must be licensed and currently registered by the appropriate state agency.
Out-of-state practitioners must be licensed and currently registered by the
appropriate agency in their state and they must provide documentation that they
participate in that state’s Medicaid and/or CHIP program. Other providers must
be approved, licensed, issued a permit, certified by the appropriate state
agency, or if applicable certified under Medicare.
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.
New Providers or Providers Closed for More Than 2 Years
Select one of the provider enrollment links to the left to start an application,
resume an existing application, or to check the status of an application.
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.
Provider Application Fee
The Affordable Care Act requires states to collect an application fee, if
applicable, prior to executing a provider agreement from a prospective or
re-enrolling provider. Refer to 42 CFR 455, Subpart E – Provider Screening and
Enrollment, Section 455.460 for the complete regulation. The Centers for
Medicare & Medicaid Services (CMS) sets the amount of the application fee every
year.
Providers may request a hardship exception to the application fee requirement.
If an exception is requested, the provider will be prompted to submit (upload)
documentation. CMS will determine whether or not to grant the hardship exception
and communicate the information back to the department. The department will
notify the provider of the CMS’ decision.
To pay an application fee, providers must enroll and revalidate through the
Electronic Provider Enrollment Application.
The department will assess and collect one fee for multiple applications
submitted by one provider in a 7 day time period. Providers who wish to submit
multiple applications (for multiple service locations) and pay one fee should
use the "Initiate Additional Application" feature and submit all applications
within 7 days.
For more information about the application fee, please see the ACA Enrollment
Application Fee Medical Assistance Bulletin. For CHIP providers, please contact
your designated CHIP Managed Care Organization(s).
Fingerprint-based Criminal Background Checks
Providers assigned to the "high" categorical risk level are required by the
Affordable Care Act to obtain fingerprint-based criminal background checks,
which include a Federal Bureau of Investigation (FBI) criminal background check
and a Pennsylvania State Police Criminal Record Check. In addition, any person
with a 5% or more direct or indirect ownership interest in the "high" risk
provider must also submit fingerprint-based background checks. Refer to 42 CFR
455, Subpart E – Provider Screening and Enrollment, Section 455.434 for detail
on the regulation.
For more information about the Fingerprint-based Criminal Background Checks and
criteria used to assign a provider to the "high" categorical risk level, please
see the Implementation of Fingerprint-based Criminal Background Checks for
Providers Assigned ACA Categorical Risk Level of High Medical Assistance
Bulletin. For CHIP providers, please contact your designated CHIP Managed Care
Organization(s).
Tracking Provider Enrollment Applications
A unique number called the "Application Tracking Number" (ATN) will be assigned
when a "New Application", "Revalidation" 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.
If you have any questions about completing an application, please refer to
"Contact Information" and call the appropriate toll free number for your
provider type.
Logout Confirmation
Are you sure you want to logout?
Logout Confirmation
If you navigate away from this page, you will lose unsaved data. Are you sure
you want to logout?
Where do I enter my password?
The way you sign into the the PROMISe™ Portal provides a better safeguard to the
privacy and security of your healthcare information. You may have signed into
other web sites by using a User ID and Password. The PROMISe™ Portal also uses
your site key token. Here is how the service works:
1. Type your User ID and click Log In.
2. Your site key token displays. If you recognize your site key token, you know
you can safely type your password. If you do not recognize your site key
token, do not type your password.
3. Your personalized site key token helps you identify that you are at the
valid PROMISe™ Portal site.
Note: If you have not created your personalized site key token, you will be
asked to do so before you sign into the PROMISe™ Portal.