Pennsylvania credentialing
Credentialing services in Pennsylvania
PROMISe Medical Assistance enrollment, HealthChoices managed-care contracting, and the regional Blues and health-plan networks that decide whether a Pennsylvania practice gets paid.
Overview
What credentialing in Pennsylvania actually involves
Pennsylvania is effectively two markets — Highmark in the west and Independence Blue Cross in the east — so we map your locations to the right regional plans before filing anything. Providers enroll through PROMISe for Medical Assistance before joining HealthChoices managed-care plans in their zone. We work with practices in Philadelphia, Pittsburgh, Allentown, Harrisburg, Scranton, and Erie.
Highmark Blue Shield covers the west and center of the state, Independence Blue Cross the southeast, with UPMC Health Plan, Geisinger, Aetna, Cigna, and UnitedHealthcare filling in, plus Medicare Part B through PECOS.
Pennsylvania Medical Assistance
Filed through PROMISe provider enrollment. PROMISe enrollment commonly runs 45–90 days, then each HealthChoices plan in your zone adds 30–90 days for contracting and roster load.
Pennsylvania Medicaid managed-care plans we enroll with
- Keystone First
- AmeriHealth Caritas / Pennsylvania Health & Wellness
- UPMC for You
- Geisinger Health Plan Family
- Highmark Wholecare
- UnitedHealthcare Community Plan
Pennsylvania licensing we handle
- Pennsylvania State Board of Medicine applications and verifications
- Allied board licensing through the Department of State (BPOA)
- Behavior specialist and behavior analyst licensure for ABA groups
- Pennsylvania controlled-substance registration and DEA address alignment
Pennsylvania licenses behavior specialists and behavior analysts, and Medical Assistance ABA services route through the HealthChoices behavioral-health contractors by county. We handle the licensure and the county-level behavioral contracting together.
FAQ
Pennsylvania credentialing questions
How long does Pennsylvania Medicaid enrollment take?
PROMISe enrollment for Medical Assistance typically takes 45–90 days from a clean submission. Each HealthChoices managed-care plan in your zone then contracts and loads the provider, usually adding 30–90 days per plan.
Do I file with Highmark or Independence Blue Cross?
It depends on where your locations are. Highmark Blue Shield covers western and central Pennsylvania, and Independence Blue Cross covers the Philadelphia region. We map each site of service to the right regional plan before any application goes out.
Do you handle UPMC and Geisinger contracting?
Yes. UPMC Health Plan and Geisinger Health Plan run their own credentialing and contracting processes on top of their Medicaid product lines, and we file both the commercial and HealthChoices sides.
Get started
Expanding in Pennsylvania?
Book a call and we'll map your Pennsylvania payers, licensing, and Medicaid timeline before you file anything.