Dpw pa promise 2025

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The document provides detailed instructions for completing the Pennsylvania PROMISe™ Provider Enrollment Base Application. It outlines the necessary steps, required information, and documentation needed for both initial enrollment and revalidation of healthcare providers in the Pennsylvania Medical Assistance Program. Key sections include provider identification, action requests, tax identification details, service location requirements, and compliance with state and federal regulations. Additionally, it includes a checklist to ensure all application components are completed correctly.

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Click ‘Get Form’ to open the dpw pa promise in the editor.
Begin by entering the complete name of the individual or facility in the designated field.
Check the appropriate boxes for your action request, such as Initial Enrollment or Revalidation.
If applicable, provide your National Provider Identifier (NPI) Number and taxonomy codes. Attach any necessary documentation.
Fill in your requested effective date and provider type number along with a description.
Complete sections regarding your specialties, including primary and sub-specialties, ensuring all codes are accurate.
Enter your Social Security Number or Tax Identification Number as required, along with supporting documents.
Provide contact information for your service location, ensuring it is a valid physical address.
Review all entries carefully before signing the application using black ink. Ensure all required documents are attached.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the PA waiver program?

What is a PA Waiver Program? A waiver program allows states to waive certain Medicaid requirements to provide care and support services to individuals who might otherwise require institutional care.

What is the Pennsylvania PROMISe Program?

Pennsylvania Promise would be available to recent high school graduates as well adults seeking in-demand skills and industry-recognized credentials, as well as college credit. The goal of the program is to reduce student debt and assist low and middle-income families with paying for higher education.

What is the state health improvement plan pa?

The SHIP identifies health priorities, goals, measurable objectives, and strategies for the next five years. The SHIP is a plan to bring together communities, organizations, and individuals to work toward common ends to advance public health in Pennsylvania.

What is the phone number for PA PROMISe?

If you have questions about obtaining a PROMISe ID or if your PROMISe ID has expired, contact PA DHS at 1-800-537-8862, select option 2, then option 4, and then option 2 for provider enrollment or revalidation questions.