To be eligible for participation in the MA program, a provider must enroll and sign a provider agreement. Providers may request enrollment information by visiting PROMISe Enrollment (pa.gov).
Providers cannot deny services or discriminate in any way against an MA recipient on the grounds of race, color, national origin, or disability.
A provider who is enrolled in the MA program must accept the payment from DHS plus any copayments from the recipient as payment-in-full. The provider may not accept any extra payment from the recipient for items or services that are covered by MA.
If a provider has a question about covered services or the billing process, the CAO will refer the provider to one of the provider inquiry telephone numbers. See Appendix H, Points of Contact, for numbers.
A provider who is enrolled in the MA program submits invoices to DHS to request payment for medical services provided to recipients. The provider submits the invoice directly to DHS. Payment is made directly to the provider through PROMISe.
If a provider invoice is rejected because of incorrect recipient ID information, the provider should check EVS to review recipient information. The provider should correct and submit the invoice. If the provider has questions, they should call an inquiry unit. See Appendix H, Points of Contact, for numbers.
If a provider does not submit an invoice within 180 days of a service, payment is rejected. Billing by the provider may be delayed because of an invoice that has been rejected in the past, an office error or delay, or a hearing decision. If the delay is more than 180 days, the provider must explain the delay and follow the 180 Day Exception process.
As soon as the CAO learns that a provider may be breaking rules, the CAO should contact the Bureau of Program Integrity:
Department of Human Services
Office of Administration
Bureau of Program Integrity
P.O. Box 2675
Harrisburg, PA 17105-2675
For more information: MA Fraud and Abuse - General Information
Updated August 26, 2025, Replacing February 14, 2012