Healthchoices health suppplemental services 2026

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4.8 out of 5

125 votes

The document provides detailed instructions for the enrollment application process for providers seeking to offer supplemental behavioral health services under Pennsylvania's HealthChoices program. It outlines the necessary forms, required documentation, and specific guidelines for completing the application, including eligibility criteria, service types, and compliance with state regulations. Key points include the acceptance of only the current version of the application, requirements for legibility and completeness, and stipulations regarding retroactive enrollment dates.

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Click ‘Get Form’ to open the HealthChoices Behavioral Health Supplemental Services Provider Enrollment Application in the editor.
Begin by checking the type of supplemental service(s) you are applying for in Section 1. Ensure you attach the required documents such as your License or Certificate of Compliance.
In Section 2, indicate the age group(s) of consumers you will serve by checking the appropriate box(es). This helps clarify your target demographic.
For Section 3, select the action requested: Initial Enrollment, Revalidation, Service Location Change, or Fee Assignment. Make sure to complete all relevant sections based on your selection.
Fill out Sections 4 through 19 with accurate information about the enrollee’s name, Tax Identification Information (TIN), National Provider Identifier (NPI), and business type. Remember to use black ink if filling out manually.
Review all entries for accuracy and legibility before signing and dating the application in Section 19. Ensure that all required attachments are included before submission.

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What is the health Choice Program in PA?

Overview. CHC has improved health care services for hundreds of thousands of Pennsylvanians who need long-term services and supports. CHC aims to enhance the quality, accountability, efficiency, and effectiveness of long-term services and supports (LTSS) for Medicaid participants in Pennsylvania.

What are supplemental health care services?

An additional insurance plan that helps pay for health care costs that are not covered by a persons regular health insurance plan.

What does UPMC Community HealthChoices cover?

HealthChoices is Pennsylvanias Medical Assistance (Medicaid) program. In HealthChoices, you choose a primary care provider () and health plan for each family member. Your is your doctor or other provider who gives you most of your regular health care.