Medical Credentialing Services in Pennsylvania

Two physician boards, and why it changes your paperwork

In most states one medical board covers every physician. Pennsylvania splits it by degree. An MD's licensure lives with the State Board of Medicine, a DO's with the State Board of Osteopathic Medicine, both run through the Bureau of Professional and Occupational Affairs.

Why does that matter to you? Every payer wants your active Pennsylvania license verified from the right source, and the right source depends on your degree. Send a DO file down the MD path and you have bought yourself a delay. We pull and document your licensure from the correct board, watch the registration so it does not lapse, and keep that record clean for every enrollment we file.

What we handle for Pennsylvania providers

Pennsylvania splits physician licensing across two separate boards (covered above) and runs Medical Assistance enrollment through PROMISe. Both quirks shape the paperwork, so we build the file around them rather than treating PA like a generic state:

Not sure where your gaps are? Tell us your specialty and market and we will scope it, or go straight to payer enrollment or provider credentialing.

Pennsylvania Medical Assistance enrollment through PROMISe

Pennsylvania calls its Medicaid program Medical Assistance, or MA, administered by the Department of Human Services. Enrollment runs through PROMISe, the state system you use to apply, attest and manage your MA provider record. Get it right the first time, because a kicked back application sends you to the back of the queue.

Now the part people underestimate. Medical Assistance runs mostly through HealthChoices, the mandatory managed care program, and PROMISe enrollment alone does not put you in network with the plans your patients carry. The HealthChoices plans, including AmeriHealth Caritas, each credential and contract on their own. We map the ones that matter for your region and enroll you with each.

Medicare runs nationally through PECOS and the CMS 855 forms. If you bill both, we sequence the Medicare and Medical Assistance work so one does not stall the other.

Pennsylvania payers we enroll you with

Most Pennsylvania practices need the big regional plans plus the national carriers. We enroll and contract you with:

One thing that makes Pennsylvania its own animal: UPMC and Geisinger are integrated payer-provider systems, and Highmark anchors its own. Enrolling with a plan that also owns hospitals is not the same as enrolling with a standalone carrier, and the path can shift by region. We will tell you straight whether a panel is open or closed in your market, instead of letting you sit on an application that was never moving.

How long credentialing takes in Pennsylvania

Honest answer: it depends on the payer. Industry typical commercial credentialing runs about 90 to 120 days from a complete, clean file. Medical Assistance through PROMISe varies, and layering several HealthChoices plans on top stretches the total. The single biggest lever is an application with no gaps, which is exactly where we earn our keep.

Frequently asked questions