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Filler promise provider enrollment base application 2011 form-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 medical suppliers to enroll in the Pennsylvania Medical Assistance Program. Key sections include guidelines for name changes, ownership changes, provider identification numbers, service location details, and compliance with federal and state regulations. Additionally, it includes a checklist to ensure all application components are completed correctly before submission.

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Versions	Form popularity	Fillable & printable
2014	4.9 Satisfied (392 Votes)
2011	4 Satisfied (39 Votes)

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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 a provider enrollment application?

In the most basic terms, provider enrollment (sometimes referred to as payer enrollment) is the process through which healthcare providers apply to be included in a health insurance network. As an in-network provider, you will be able to treat patients who carry that insurance and be reimbursed for your services.

What does provider mean on an insurance form?

Providers can include doctors, psychologists, or physical therapists, and health care facilities, like hospitals, urgent care clinics, or pharmacies. Insurance companies may have different networks for different plans, so make sure you search the provider network of each specific plan you compare.

Why is provider enrollment important?

Why Is Provider Enrollment Important? Provider enrollment allows providers to join the insurance plans accepted by their healthcare organization or practice. Its also a legal requirement. Most insurance companies and government payers, like Medicare, require providers to be enrolled before they can submit claims.

How to get a PROMISe ID in PA?

Apply for a PROMISe ID using the PA DHS online enrollment application. Ensure that PA DHS has the correct address (including the suite and/or building number and full nine-digit ZIP code) and associated NPIs for all provider locations, and that each of your provider locations has a PROMISe ID.

What is the purpose of a health enrollment form?

Enrollment forms record whether employees have enrolled in or waived group benefits. For instance, if you have more than 50 full-time employees, you will need this data to complete IRS forms 1094 and 1095, which record health care coverage.