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Pennsylvania Medicaid
Pennsylvania Medicaid, revalidated and paid
An active Pennsylvania Medicaid ID, every service location revalidated on time, and no closed locations.
Pennsylvania Medicaid enrollment is tracked service location by service location, and each location has its own revalidation date. The Department of Human Services lists the steps on its Enroll as a Medicaid Provider page.
Revalidation cycle
All providers must revalidate the Medical Assistance enrollment of each service location every 5 years. Pennsylvania DHS, Medical Assistance Bulletin, August 21, 2026
When to submit
Providers should submit revalidation applications at least 60 days prior to the revalidation dates. Pennsylvania DHS, Medical Assistance Bulletin, August 21, 2026
High risk deadline
Providers categorized as high risk who revalidated before July 1, 2025, and select others, must revalidate again no later than December 31, 2026 to remain enrolled. Pennsylvania DHS, Medical Assistance Bulletin, August 21, 2026
Missed deadline
A high risk service location is closed if revalidation is not completed by the due date on its notices. Pennsylvania DHS, Medical Assistance Bulletin, August 21, 2026
What we see in practice
45 to 90 days from submission to an active Medicaid ID.
In the official words
To be eligible for enrollment as a Medicaid provider, practitioners in Pennsylvania must be licensed and currently registered by the appropriate state agency.
High-risk providers must submit a revalidation application by the due date indicated on their 90-day and 30-day revalidation notices.
High risk providers must revalidate again by December 31, 2026
A Medical Assistance Bulletin issued August 21, 2026 on off cycle revalidation of high risk providers sets a second deadline for two groups: high risk providers who revalidated before July 1, 2025, and select high risk providers who revalidated on or after that date. Both must revalidate again by December 31, 2026 to stay enrolled. Pennsylvania DHS, Medical Assistance Bulletin, August 21, 2026
CMS asked the department for a swift revalidation of high risk providers and a two year revalidation strategy. The department submitted its plan on June 5, 2026, and the plan requires revalidation of all high risk providers and provider types enrolled in the program by December 31, 2026. Pennsylvania DHS, Medical Assistance Bulletin, August 21, 2026
A provider is high risk when it meets one of several criteria. They include a payment suspension based on a credible allegation of fraud, waste or abuse, exclusion from Medicare or another state's Medicaid or CHIP program by the U.S. Department of Health and Human Services Office of Inspector General within the last ten years, and an outstanding overpayment greater than $1,500 that is more than 30 days old, is not being appealed and is not on an approved repayment schedule. Pennsylvania DHS, Medical Assistance Bulletin, August 21, 2026
Affected providers receive individual communication at the email address on their provider file. They must submit the revalidation application by the due date on their 90 day and 30 day notices. Pennsylvania DHS, Medical Assistance Bulletin, August 21, 2026
The next revalidation date for these providers is December 2028, and they then shift to a five year revalidation cycle. Pennsylvania DHS, Medical Assistance Bulletin, August 21, 2026
How enrollment works, step by step
- Confirm eligibility. Practitioners in Pennsylvania must be licensed and currently registered by the appropriate state agency. Other providers must be approved, licensed, issued a permit or certified by the appropriate state agency and, if applicable, certified under Medicare. Pennsylvania DHS, Enroll as a Medicaid Provider
- Get the application for your provider type from the Provider Enrollment Documents page, which holds enrollment and revalidation applications and requirements for each provider type. Pennsylvania DHS, Enroll as a Medicaid Provider
- If the provider is high risk, complete the criminal background checks, and have anyone with a five percent or greater direct or indirect ownership interest do the same. Pennsylvania DHS, Enroll as a Medicaid Provider
- Ask each managed care organization about its network separately. Enrollment in the Medicaid program does not guarantee enrollment in individual managed care organization networks, and new providers should contact each organization directly. Pennsylvania DHS, Enroll as a Medicaid Provider
In Pennsylvania the time follows the application for your provider type and the locations it covers. Each service location has its own revalidation date, and a high risk provider, or anyone with a five percent or greater ownership interest in one, adds criminal background checks. More locations and more screening mean more to finish. Our planning figure is 45 to 90 days from submission to an active Medicaid ID.
Risk screening and routine revalidation
The department has assigned certain provider types and specialties to the high categorical risk level. The Affordable Care Act requires providers deemed high risk to obtain criminal background checks, and any person with a five percent or greater direct or indirect ownership interest in a high risk provider must also submit criminal background check information. Pennsylvania DHS, Enroll as a Medicaid Provider
Treat each service location as its own calendar item. Log into PROMISe to check the revalidation date of each location, and file the application at least 60 days ahead of it, since the routine cycle is 5 years per location. The electronic revalidation application is available from the My Home page after logging in. Pennsylvania DHS, Medical Assistance Bulletin, August 21, 2026 Pennsylvania DHS, Provider Enrollment FAQ
Keep contact information on the provider file current. Pennsylvania DHS, Medical Assistance Bulletin, August 21, 2026
Where Pennsylvania enrollments lose money
Check the due date on both notices, because a missed date closes the location in PROMISe, and that closure is the consequence the bulletin names. Pennsylvania DHS, Medical Assistance Bulletin, August 21, 2026
An unpaid debt can put a provider in the off cycle group. A provider with an outstanding overpayment greater than $1,500 that is more than 30 days old stays categorized as high risk until the overpayment is repaid. Pennsylvania DHS, Medical Assistance Bulletin, August 21, 2026
State enrollment does not mean network participation. Enrollment in the Medicaid program does not guarantee enrollment in individual managed care organization networks. Pennsylvania DHS, Enroll as a Medicaid Provider
Check where you stand before you submit
WeBill Health runs Revenue Velocity Credentialing with 24/7 CAQH and PECOS lifecycle monitoring, so revalidation dates and affiliation gaps are caught before they become suspended claims. Every file gets Human Expert Review from a credentialing specialist before it goes to the state.
Revenue Velocity Credentialing
WeBill Health manages the full payer enrollment lifecycle, so your revenue cycle starts the moment your practice does.
Up to 40%
less payer enrollment lag against the industry baseline
24/7
CAQH and PECOS lifecycle monitoring
Review your enrollment status with us
The Revenue Defense Audit is a free, forensic review of your claims and A/R by the team that would work your account, including providers seeing patients under a payer that cannot pay them yet.
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