MedicaidAdministrativeMedium impact
Enrollment of Co-Located Providers MAB 99-16-04
Pennsylvania Medicaid (DHS)·PA·Eligibility
Effective date
May 31, 2016
We identified it
Jun 20, 2026
Summary
Pennsylvania Department of Human Services has established a new process for enrolling or revalidating Medical Assistance providers that share the same physical address with other enrolled providers. Both co-located providers must complete a Co-Location Attestation form and submit proposed signage language to continue enrollment.
Action Required
For providers co-located with other Medical Assistance enrolled providers at the same address: Both providers must complete the Co-Location Attestation form and submit proposed signage language to RA-ProvApp@pa.gov, DHS Enrollment Unit PO Box 8045 Harrisburg PA 17105-8045, or fax (717) 265-8284. Display approved signage in waiting room or check-in area advising patients of freedom of choice. Complete revalidation applications at least 60 days prior to expiration date via PROMISe system.