Physician Assistants (PAs) who order, refer, or prescribe items or services for Medicaid patients must enroll as participating providers in Medicaid — known in Pennsylvania as Medical Assistance (MA).
As of June 2017, PAs can now use the electronic portal to enroll, revalidate, or reactivate, as MA providers, via the following link: https://provider.enrollment.dpw.state.pa.us. Prior to this change, physician assistants had been required to submit paper enrollment applications.
When submitting an application through the portal, choose the Mid-Level Practitioner, provider type 10 as the "Provider Type."
Below are a few points to keep in mind regarding MA enrollment for PAs:
- PAs that enroll in the MA Program will be enrolling only to enable them to order, refer, or prescribe for MA patients. Their enrollment does not enable them to be paid for MA services.
- The Pennsylvania Department of Human Services (DHS) says that PAs employed by or having a contract with an MA enrolled practitioner or medical service provider should enroll in the MA Program and receive a MA provider number in order for the MA covered services they order, refer or prescribe to be paid.
- Unlike physician enrollees who practice in multiple locations, PAs are only required to enroll in one service location, despite the fact that a PA might be practicing out of multiple locations.
- Claims submitted to DHS' PROMISe internet portal with an NPI number in the field for an ordering or referring provider, who is not enrolled or revalidated in the MA program, automatically generate a "not on file" message on the claim remittance advice. The message alerts the billing provider that the ordering, referring or prescribing provider is "not on file" and must enroll or revalidate in the MA Program.
- Claims will deny if the ordering, referring or prescribing provider is not enrolled in the MA program.
Pennsylvania Medical Society (PAMED) members with questions can contact PAMED's Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.