Omhsas healthchoices bh mco attestation form and attachments 2025

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The document is a Provider Enrollment Application for the HealthChoices Behavioral Health Supplemental Services in Pennsylvania. It outlines the steps and requirements for new providers seeking enrollment, including necessary information such as tax identification, national provider identifier, business type, and counties served. The application also includes sections for confidential information, physical service location, and additional required forms. Furthermore, it details the process for fee assignment within provider groups and includes definitions related to ownership and control interests.

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What is the purpose of the Provider Enrollment Application?

The Provider Enrollment Application is used to request enrollment as a new provider, expand existing enrollment, or change service locations within the HealthChoices Behavioral Health Supplemental Services program.

What documents are required to accompany the application?

Required documents include a copy of your Social Security card, Tax Identification Number (TIN) documentation, National Provider Identifier (NPI) confirmation letter, and any applicable licenses or certificates.

How do I check the type of supplemental services I can apply for?

You can check the types of supplemental services by reviewing Section 8 of the application where various service categories are listed along with their requirements.

What should I do if I have moved my service location?

If you have moved your service location, you should check 'Service Location Change' on the application and include a Service Location Change Form to close your old location.

Is there a specific format for signing the application?

Yes, the application must be signed in black ink by the individual applying for enrollment or an authorized representative. Stamped signatures are not acceptable.

Does Medicaid cover mental health in PA?

If you are enrolled in Medicaid for your physical health care, you also have access to mental health and substance use disorder treatment through Behavioral HealthChoices. If you are not on Medicaid and are having trouble paying for behavioral health care, your county mental health office may be able to help.

What counties are in PerformCare PA?

PerformCare works in partnership with Cumberland, Dauphin, Lancaster, Lebanon, and Perry counties.

Does Montgomery County PA have Medicaid for behavioral health?

Medical Assistance (MA/Medicaid/Health Choices) MA provides important funding for behavioral health services, medicines, and medical care. Information for obtaining Medical Assistance (MA) can be obtained at the Montgomery County Assistance Office, in several ways: By phone: (610) 270-350.

What is covered under Pennsylvania Medicaid?

Medicaid covers a broad range of physical and behavioral health services, including doctor visits when youre sick, preventive care like health screenings, vaccines, hospital stays, prescription medications, mental health and substance use disorder care, and more.

Does Medicaid support mental health?

Medicaid pays for vital services that people with mental health conditions rely on, such as medications, psychotherapy, intensive and inpatient treatment, peer support, and crisis care.

Omhsas healthchoices bh mco attestation form and attachments 2025

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