Enrollment in Pennsylvania’s PROMISe

Pennsylvania PROMISe Accepted

In order for Agency providers to participate with the Department of Human Services, they must first enroll. To be eligible to enroll, practitioners in Pennsylvania must be licensed and currently registered by the appropriate state agency. Out-of-state practitioners must be licensed and currently registered by the appropriate agency in their state and they must provide documentation that they participate in that state’s Medicaid program.

Other providers must be approved, licensed, issued a permit or certified by the appropriate state agency, and if applicable certified under Medicare. To enroll, providers must complete a Base Provider Enrollment form and any applicable addenda documents dependent on the provider type.

Once Liberty get’s your new Agency licensed, what’s next? In order for your Agency to participate with the Department of Human Services they must first enroll in Pennsylvania’s PROMISe Program. Liberty files your Agency’s Base Provider Enrollment Application along with providing the applicable addenda documents, including:


  • Obtaining your Agency’s National Provider Identifier (NPI) Number,
  • Properly identifying your Agency taxonomy(s) codes,
  • Properly enroll your Agency in the Electronic Funds Transfer Direct Deposit plan, and
  • Properly enrolling your Agency in a Waiver Program.

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Taylor M. Fletcher, Esquire ​is the Founder and Principle of Liberty Licensing & Consulting, LLC.