Traditional MedicareAdministrativeMedium impact
MAB2022110405
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Nov 17, 2022
We identified it
Jun 20, 2026
Summary
Medicare providers who are not currently recognized under Pennsylvania's Medical Assistance (Medicaid) program can now enroll for cost-sharing billing only for dual-eligible patients. This creates new Provider Type/Specialty combinations 01/600 and 10/600 specifically for Medicare cost-sharing claims.
Action Required
By November 17, 2022: Medicare providers not currently enrolled in PA Medicaid should complete online enrollment application for Provider Type/Specialty 01/600 (Entity/Group) or 10/600 (Individual Practitioners) if they treat dual-eligible patients. Contact Provider Enrollment at (800) 537-8862, option 2, then option 4 for enrollment questions. This only applies to cost-sharing claims for patients with both Medicare and Medicaid coverage.