Pennsylvania Medicaid Provider Agreement

Firms currently in charge of Aetna Better Health can now register new providers by filing an online application to start the process. To register, providers can complete an online vendor registration application and provide the necessary support documentation. These include providers that do not charge PA Medicaid or CHIP, but provide services to beneficiaries. All applications are reviewed prior to making a registration decision based on federal and regional guidelines. Please keep copies of your application file for your documents. You will receive a response after the agreement or refusal to register with PA Medicaid and/or CHIP. For more information on criminal background fingerprint checks and the criteria used to assign a provider to the “high-level” category risk level, you will find in the implementation of fingerprint-based criminal background checks for suppliers to whom ACA has been assigned a category risk level of the High Medical Assistance Bulletin. For CHIP suppliers, contact your CHIP designated Managed Care Organization (s). To pay a registration fee, suppliers must register and re-validate via the electronic provider`s registration app.

The Office of Developmental Programs (ODP) published on Tuesday, 14 January 2020, an opinion on the new provider agreement for participation in the Pennsylvania Consolidated Waiver, Adult Autism Waiver and Community Waiver Programs, which will serve as a “national provider agreement” between unfunded service providers and the ODP, Department of Human Services, as the Pennsylvania State Medicaid Agency, effective January 1, 2020. If you are an unrelated provider who wishes to join our network, you can submit an application via our online portal or download and complete the forms passed to send an email to or fax to 1-877-533-5887. Existing participating vendor groups can continue to fill the vendor`s individual application if you want to register other vendors. The app can be emailed to or faxed to 1-860-754-5435. You have a team of Provider Experience collaborators dedicated to taking care of your needs, starting with the onboarding process of suppliers. They assist you with ongoing training, patient care, billing support and more. The department evaluates and collects a fee for several applications submitted by a supplier over a 7-day period. Suppliers who wish to submit multiple applications (for multiple service sites) and pay a fee should use the “Launch an Additional Application” feature and submit all applications within 7 days.

Fingerprint-based Criminal Background Checks Providers attributable to the “high” category risk level is required under the Affordable Care Act to obtain criminal background fingerprint checks, including a background review of the Federal Bureau of Investigation (FBI) and a criminal record review of the Pennsylvania State Police. In addition, anyone with a direct or indirect interest of 5% or more in the high-risk provider must also submit fingerprint-based background examinations. Detailed settlement information can be found in 42 CFR 455, subsection E – Screening Provider and Enrollment, Section 455.434. Past agreements can also be sent by traditional email to: Types of vendor registration applications There are three types of registration requests for which each provider must run a full application.