MedicaidAdministrativeHigh impact
MAB2026082101
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Aug 21, 2026
We identified it
Aug 22, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing an off-cycle revalidation requirement for all high-risk providers. High-risk providers must revalidate their MA enrollment by December 31, 2026, to remain enrolled. Failure to revalidate by the deadline will result in service location closure in the PROMISe system.
Action Required
By December 31, 2026: Billing team must identify whether your practice is classified as a high-risk provider per the five criteria listed (payment suspension for fraud/waste/abuse, HHS OIG exclusion within 10 years, outstanding overpayment >$1,500 and >30 days old, enrollment within 6 months post-moratorium lift, or enrollment as Human Milk Bank PT 25/Spec 256 or Diabetes Prevention Program PT 55/Spec 223). Check PROMISe system immediately to confirm revalidation dates for all service locations. Upon receipt of individual communication from PA DHS to enrolled email address, submit revalidation application at least 60 days before the due date indicated in 90-day and 30-day revalidation notices. Update provider contact information in PROMISe to ensure receipt of notices. Obtain revalidation applications at https://www.pa.gov/agencies/dhs/resources/for-providers/provider-enrollment-information/provider-enrollment-documents. Failure to complete revalidation by specified due dates will result in automatic service location closure and loss of MA enrollment eligibility.