MedicaidAdministrativeHigh impact
New requirements for physician extenders
UPMC Health Plan·PA·Provider Announcement
Effective date
Jan 7, 2022
We identified it
Aug 7, 2026
Summary
Effective January 7, 2022, Pennsylvania DHS now requires CRNPs and PAs to register with PA DHS and obtain a PROMISe ID to render, refer, order, or prescribe services for UPMC health plans (UPMC for You, UPMC Community HealthChoices, UPMC for Kids). Unregistered extenders will face claim denials under UPMC's new guidelines.
Action Required
By January 7, 2022: Billing and credentialing teams must verify that all CRNPs and PAs rendering services for UPMC for You, UPMC Community HealthChoices, or UPMC for Kids members are registered with PA DHS and have active PROMISe IDs. Update internal provider rosters and credentialing files to document registration status. Implement a verification process to flag unregistered extenders before claim submission to prevent denials. Direct any unregistered CRNPs and PAs to enroll immediately via PA DHS online portal or by calling UPMC Health Plan Provider Services at 1-866-918-1595. After the effective date, claims submitted by nonregistered extenders will be denied per DHS guidelines.