- Providers will need to create a password for each application
- Each online provider enrollment application is assigned a unique Application Tracking Number (ATN)
- Providers will be able to resume a previously started application or check status of a submitted application
- Provider Type and Provider Specialties that are able to be submitted into the portal for CCRI is listed below.
- CCRI Short Form will be required if the service is already enrolled as a state plan service
- Comprehensive list that includes every combination of procedure code and modifier for the PT/PS
Electronic Provider Enrollment Application https://provider.enrollment.dpw.state.pa.us
Provider Enrollment Information
http://www.dhs.pa.gov/provider/healthcaremedicalassistance/enrollmentinformation/index.htm
Includes information regarding requirements for each Provider Type and links to the Department’s provider enrollment forms
Department of Human Services Website
http://www.dhs.pa.gov/
MAB 99-14-06 – Re-enrollment/Revalidation of Medical Assistance (MA) Providers
http://www.dhs.pa.gov/cs/groups/webcontent/documents/bulletin_admin/c_074003.pdf
Provider Enrollment Questions
http://www.dhs.pa.gov/learnaboutdhs/helpfultelephonenumbers/contactinformationhelpformaproviders/index.htm#.Vp-jk01Ii70
Includes contact information and help for MA Providers