Pennsylvania’s HealthChoices program divides the state into five managed care zones with different MCO lineups in each zone, and the state’s county-based behavioral health carve-out adds a second enrollment layer that is completely independent of physical health MCOs.
What Is the PROMISe Portal?
PROMISe (Provider Reimbursement and Operations Management Information System in an Electronic environment) is Pennsylvania’s centralized provider enrollment and claims portal.
Step-by-Step PA Medicaid Enrollment
Register on PROMISe
Create account with NPI, Tax ID, PA license, practice info.
Complete Application
Demographics, PA license, specialties, locations, ownership disclosures, billing config.
Upload Documents
PA license, NPI, W-9, EIN, liability insurance, DEA, voided check, board cert.
Complete Screening
OIG/SAM, PA licensing board, PSP background for high-risk, site visits for facilities.
Submit
Processing: 30–45 days.
Credential with Zone-Specific MCOs
After PROMISe approval, credential with the HealthChoices MCOs serving your zone.
HealthChoices: Five-Zone MCO System
Pennsylvania divides the state into five HealthChoices managed care zones, each with a different MCO lineup.
| Zone | Region | Key MCOs |
|---|---|---|
| Southeast | Philadelphia area | Keystone First, Health Partners Plans, Aetna, UHC |
| Southwest | Pittsburgh area | UPMC Health Plan, Gateway Health, UHC |
| Lehigh/Capital | Central-East PA | AmeriHealth Caritas, Geisinger, UHC |
| Northeast | Scranton/Wilkes-Barre | Geisinger Health Plan, UHC |
| Northwest/Central | Erie/State College | UPMC, Gateway, UHC |
⚠ Zone Lock: MCO lineups differ by zone. UPMC Health Plan is dominant in Pittsburgh but not available in Philadelphia. Keystone First dominates Philadelphia but doesn’t serve western PA. Research YOUR zone before credentialing.
Behavioral Health Carve-Out
Pennsylvania carves out behavioral health through county-based BH-MCOs that are completely separate from physical health HealthChoices plans.
- BH services are managed by county-level Behavioral Health Managed Care Organizations
- Providers must enroll with both PROMISe (state) AND the county BH-MCO
- Community Behavioral Health (CBH) manages Philadelphia County BH
- Each county or multi-county region has its own BH-MCO with separate credentialing
⚠ BH Alert: PA’s physical health MCOs do NOT manage behavioral health. BH providers must separately credential with county BH-MCOs. This is a completely independent enrollment track.
✔ Philly Strategy: For Philadelphia: credential with Keystone First + Health Partners (physical) AND Community Behavioral Health/CBH (BH). For Pittsburgh: UPMC + Gateway (physical) AND county BH-MCO.
Frequently Asked Questions
How long does PA enrollment take?
PROMISe: 30–45 days. MCO + BH-MCO: 30–60 days. Total: 60–105 days.
Is BH separate from physical health?
Yes. PA carves out BH through county BH-MCOs. Separate enrollment required.
Do MCOs differ by region?
Yes. PA has 5 zones with different MCO lineups. Research your zone.
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