Use the Online Provider Enrollment Portal to submit a new application, apply for a revalidation, or request a reactivation.
Benefits of using the secure online portal:
Providers seeking to enroll at a site that is located within another provider's office may complete the attestation form and submit it and proposed signage to the department. Please follow the directions specified in the MA Bulletin 99-16-04. The attestation forms are attached to the bulletin.
The Department of Human Services has assigned certain provider types and specialties to the "high" categorical risk level. The Affordable Care Act (ACA) requires all providers deemed to be a high categorical risk level to obtain criminal background checks, which include a Federal Bureau of Investigation (FBI) criminal background check and a Pennsylvania State Police Criminal Record Check. Any person with a 5 percent or greater direct or indirect ownership interest in the high risk provider must also submit criminal background check information. For more information, please see Medical Assistance Bulletin 99-17-03 or visit the OMAP section of the Provider Clearances and Background Checks page.
To access enrollment or revalidation applications and requirements for each Medical Assistance provider type visit the Provider Enrollment Documents page.