Enrollment of Physician Assistants in the Pennsylvania Medical Assistance Program
Physician Assistants (PAs) who order, refer, or prescribe items or services to Pennsylvania Medical Assistance (MA) beneficiaries need to enroll as participating providers in the MA program. Historically PAs have not enrolled as MA program providers. However as required by the Affordable Care Act (ACA) and implementing regulation all providers including those who order, refer, or prescribe items or services for MA beneficiaries must enroll in the MA program. Beginning September 25, 2016, claims will deny if the ordering, referring or prescribing provider is not enrolled in the MA program. PAs who order, refer, or prescribe items or services to MA should access the Department of Human Service Enrollment Information website at the following link:
PAs should complete and submit a provider type 10 – Mid Level Practitioner. Please review the “Requirements/Additional Information” instructions on what to include when submitting the application. PAs are not currently able to use the online application and must submit a paper application.
Medicaid is a program whereby federal and state governments share the cost of providing approximately 58 million needy Americans with health care coverage. To qualify for the program, states must include hospital services, prevention services, skilled nursing and home health care coverage for adults, and prevention and treatment services for children. Unlike Medicare, Medicaid has a state funding component, and allows each state to write its own rules for medical coverage. Therefore, every state may define PA scope of practice and reimbursement rules.
Please contact the Reimbursement Committee Chair with any questions.