I am enrolled in PROMISe. Why can I still not bill a Medicaid plan?

Enrolling and joining are two different steps. DHS says plainly that enrolling in Medical Assistance does not put you in an MCO network, that you contact the plans yourself, and that some networks may be closed. The rule runs the other way too: under 42 CFR 438.602(b) and 438.608(b) you must be enrolled in Medical Assistance to be a network provider for any Pennsylvania Medicaid managed care organization, behavioral health MCOs included. There is no uniform behavioral health application, so each of the five MCOs applies its own process.

Pennsylvania

Pennsylvania Behavioral Health Credentialing: PROMISe, County BH-MCOs and Commercial Payers

Q: Which behavioral health plan pays me for a Pennsylvania Medicaid patient?

The one your patient's county contracts with, not the plan on their physical health card. Behavioral health is carved out of HealthChoices in all 67 counties, and the county, or a multi-county alliance or joinder, subcontracts to a behavioral health MCO. Community Care covers 41 counties, Carelon 11, Magellan 7, PerformCare 7, and Philadelphia runs its own plan, Community Behavioral Health. Serve three counties and you may need two or three contracts, sometimes with the same MCO, because each county program is contracted separately.

Q: Should a psychiatric nurse practitioner take Highmark's APP enumeration track?

Ask hard before you agree to it. Enumeration adds an advanced practice provider to eligible Highmark networks for billing under their own NPI and skips credentialing, and CRNPs are on the Pennsylvania eligible list. But Highmark's own guide says enumerated APPs are not listed in the provider directory and are reimbursed at a lower rate than fully credentialed providers. You can do everything right, get in quicker, and end up invisible to patients searching for a provider while every claim pays less. We confirm the track before anything goes in.

Q: How do I join UPMC Health Plan's behavioral health network?

You do not apply to UPMC. Community Care Behavioral Health contracts and credentials behavioral health for UPMC Health Plan commercial, UPMC for Kids CHIP, UPMC for Life Medicare and Complete Care D-SNP, and it is separately the Medicaid behavioral health MCO for 41 counties. Its new provider credentialing inquiry has you tick every applicable HealthChoices county program and every applicable UPMC product on one intake, so one correctly routed application can open Medicaid behavioral health in several counties plus commercial. Applying to core UPMC medical is the classic wasted month here.

Q: Is there a credentialing deadline in Pennsylvania?

No. 40 P.S. 991.2121 requires an insurer or a Medical Assistance and CHIP managed care plan to run a Department-approved credentialing process, disclose its criteria, report at least every two years, and give a written rationale on denial. 28 Pa. Code 9.761 adds recredentialing at least every three years. Neither sets a deadline for deciding your application, and neither creates a standard application or a state database. House Bill 544 would add timing requirements, and it was referred to the House Insurance Committee on February 10, 2025 without moving. Every timeline here is a payer's own practice.

Q: Can I see patients while my Pennsylvania credentialing application is pending?

Two carriers tell you in writing not to. Highmark says do not see members or submit claims until you are notified of acceptance. Capital Blue Cross says do not schedule services with its members until you hold written notification that credentialing is complete and confirming your effective date. Pennsylvania has no back pay rule to fall back on if you go early. Plan the go-live off the approval letter rather than the submission date.

Q: Do I need all three Blue plans in Pennsylvania?

It depends where you practice. Highmark runs as Highmark Blue Cross Blue Shield in the west and northeast and as Highmark Blue Shield in the center and southeast. Independence Blue Cross holds the Blue Cross license for Bucks, Chester, Delaware, Montgomery and Philadelphia. Capital Blue Cross holds it for 21 central and Lehigh Valley counties. Because the two licenses are split in the center and southeast, covering the full in-state Blue population there usually means Highmark Blue Shield plus either Capital or Independence. Regional licensees inside one state, not a contract per state, and BlueCard reaches Blue members elsewhere when you are licensed there.

Q: Do you need my CAQH password?

No, and we will not ask. We are added as an authorized practice manager, which lets us keep your practice data current and authorize each payer. You complete and attest your own profile and you sign your own paper applications. Two Pennsylvania wrinkles: Highmark asks for global access rather than authorizing plan by plan, and Community Care treats an attestation as valid for only 180 days.

Pennsylvania has the most complicated behavioral health structure in the country, and it’s county-based. Medicaid behavioral health is carved out of HealthChoices in all 67 counties, so your patient’s county decides who pays you, not the card in their wallet. Commercial adds three Blue licensees and a big behavioral health network that isn’t run by the carrier whose name is on it. There’s no state credentialing clock here either, which makes the order you do things in the whole job.

See what we need from you
Pennsylvania payers and timelines

The Pennsylvania rule worth knowing

Your Medicaid behavioral health payer is set by county, and there are 67 of them.

The county, or a multi-county alliance or joinder acting for several counties, is the primary contractor with the Department of Human Services, and it subcontracts the managed care work to a behavioral health MCO. Five of them cover the Commonwealth: Community Care in 41 counties, Carelon Health of Pennsylvania in 11, Magellan Behavioral Health of Pennsylvania in 7, PerformCare in 7, and Philadelphia’s own Community Behavioral Health in 1.

So the plan on your patient’s physical health card is almost never the payer for their outpatient visit. Draw patients from three counties and you can be looking at two or three separate contracts, sometimes with the same MCO, because each county program is contracted separately. The Philadelphia suburbs show it best. Bucks and Montgomery are Magellan, Chester and Delaware are Community Care, Philadelphia is CBH. Four counties in one metro, three payers, none of them chosen by the patient.

There’s no shortcut through it. DHS’s own credentialing standards page says each behavioral health MCO runs its own process, so Pennsylvania has no uniform behavioral health application and no single form that opens all five doors. The county layer lands in your paperwork too. Cumberland, Dauphin, Lancaster, Lebanon and Perry contract through the Capital Area Behavioral Health Collaborative, Franklin and Fulton through the Tuscarora Managed Care Alliance, and roughly two dozen rural counties sit under a single primary contractor.

Pennsylvania also gives you nothing to lean on while you wait. No statutory credentialing clock, no state credentialing database, no back pay protection. House Bill 544 would create timing requirements; it was referred to the House Insurance Committee on February 10, 2025 and has sat there since. Every timeline on this page is a payer’s own stated practice, not a right you can enforce. That’s why sequencing is worth money here.

Credentialed›contracted›loaded›connected›payable

On the Medicaid side that first box gets decided five different ways, and the county program above the MCO can add its own requirements. The other four are the same grind as anywhere, and they’re where most of the waiting lives.

Two tracks

Medicaid enrolls your location. Commercial credentials you, carrier by carrier.

Both halves of this market are split, and a prescriber feels it twice. Medicaid splits by county. Commercial splits by Blue licensee and by which door behavioral health goes through.

Pennsylvania Medical Assistance

PROMISe first, then the counties.

Everything starts in PROMISe, filed through the Online Provider Enrollment portal at promise.dhs.pa.gov. You get an Application Tracking Number the moment you start, and the ATN plus your tax ID is how anyone resumes an application or checks status. Two numbers get enrolled: your individual one identifies the rendering provider on a claim, the group one identifies who gets paid.

Per location, not per personThe most misunderstood thing about enrolling here. Each service location is enrolled and revalidated separately, every five years, filed at least 60 days before the date on file. DHS repeats that at the top of every Medical Assistance Bulletin, including the one issued March 19, 2026. Add or move a site and you’re carrying several dates at once, and a lapse says nothing until claims from that address stop paying.

The five behavioral health plans

Community CareCarelon Health of PAMagellan of PAPerformCareCommunity Behavioral Health

Enrolling is not joiningDHS says it plainly: enrolling in Medical Assistance does not put you in an MCO network, you contact the plans yourself, and some networks may be closed. It runs the other way too. Under 42 CFR 438.602(b) and 438.608(b) you must be MA-enrolled to be a network provider for any Pennsylvania Medicaid managed care organization, behavioral health MCOs included.

Order that saves monthsPROMISe, then your county map, then the behavioral health MCOs. If any of your counties fall under Community Care, start there, because the same intake reaches UPMC Health Plan’s commercial, CHIP, Medicare and D-SNP networks. Physical health MCO contracts come last for a prescriber and often not at all.

Commercial

Three Blues, and a different behavioral door at nearly every carrier.

Highmark operates as Highmark Blue Cross Blue Shield in the west and northeast and as Highmark Blue Shield in the center and southeast. Independence Blue Cross holds the Blue Cross license for the five Philadelphia counties, Capital Blue Cross for 21 counties in central Pennsylvania and the Lehigh Valley. Because the two licenses are split in the center and southeast, covering the full in-state Blue population there takes two Blue contracts. Regional licensees inside one state, which is a different thing from a contract per state.

Where behavioral health actually entersUPMC Health Plan routes it to Community Care. UnitedHealthcare routes it to Optum, started in Provider Express. Cigna routes it to Evernorth. Aetna keeps it in house but on a separate behavioral request form. Highmark, Independence, Capital and Geisinger manage it inside the plan. Applying through the medical door where a behavioral door exists is the most expensive self-inflicted delay in this state.

The Highmark APP enumeration trapHighmark runs an Advanced Practice Provider enumeration track alongside full credentialing. It adds you to eligible networks for billing under your own NPI and bypasses credentialing, and CRNPs are on the Pennsylvania eligible list. It reads like the fast lane. But Highmark’s own guide says enumerated APPs are not listed in the provider directory and are reimbursed at a lower rate than fully credentialed providers. Faster is not better if patients can’t find you and every claim pays less.

No clock, and no bridge40 P.S. 991.2121 requires a Department-approved credentialing process, disclosed criteria, reporting at least every two years, and a written rationale on denial. 28 Pa. Code 9.761 adds recredentialing at least every three years. Neither sets a deadline for deciding your application. There’s no retroactive payment right either, and two carriers say the opposite out loud: Highmark tells you not to see members or bill until notified of acceptance, and Capital tells you not to schedule members until you hold written notice of your effective date.

Seeing patients in other statesAetna, Cigna and UnitedHealthcare are national, so one contract each covers every state you’re licensed in, and one Blue contract reaches Blue members elsewhere through BlueCard. The gate is a license where the patient is sitting. Medicaid is the exception, and Pennsylvania’s is per county on top of per state.

Pennsylvania commercial payers

Who you’ll apply to, and where behavioral health really goes.

These are typical ranges from a complete application, and every one is the payer’s own stated practice. No Pennsylvania statute backs any of it, so we track and push rather than promise.

Highmark

Blue Cross Blue Shield in the west and northeast, Blue Shield in the center and southeast

Usually: a published goal of completion within 45 days of a complete application, extended by volume or a request for more information. A goal, not a promise. Recredentialing at least every three years
Don’t apply early: an initial application can’t go in more than six weeks before your intended start date
Path: CAQH Provider Data Portal with Highmark granted global access, then the Initial Credentialing Request Form, which since November 3, 2025 ends in the Certify portal
The APP question: the enumeration track skips credentialing but leaves you out of the provider directory and on a lower rate. Confirm which track you’re on before you submit, and don’t see members or bill until you’re notified of acceptance

UPMC Health Plan

Behavioral health is contracted and credentialed by Community Care, not by UPMC

Usually: no published turnaround. Community Care’s standard sets the outer bound at approval within 180 days of the date the application was signed, and a CAQH attestation is good for 180 days too
One intake, two markets: the credentialing inquiry has you tick every applicable HealthChoices county program and every applicable UPMC product, so one application can open Medicaid behavioral health in several counties plus UPMC commercial, UPMC for Kids, UPMC for Life and Complete Care
Prescribers are practitioners here: the contracted list names doctoral and master’s level CRNPs and clinical psychiatric nurse specialists alongside psychiatrists
After you’re in: an appointment within seven calendar days of request, quarterly ePortal data validation, and recredentialing at a maximum of every 36 months

Separate door: Community Care Behavioral Health

Independence Blue Cross

The Blue Cross licensee for the five Philadelphia counties

Usually: no published clock. Commercial behavioral health here commonly runs 60 to 120 days from a complete application
The 30-day trap: once the contract goes out through DocuSign you have 30 calendar days to sign and return it or the application is rescinded and you start over
Path: the Practitioner Participation Form, then CAQH Provider Data Portal with IBX Credentialing given permission to pull your file
In house, with a caveat: the April 2026 behavioral health manual says IBX contracts directly for most HMO, POS, PPO, EPO, Federal Employee Program and indemnity members, but benefits vary by employer group. Supervised LSW, LMSW, LAMFT and LAPC work bills under the supervising credentialed practitioner with the AJ modifier

Capital Blue Cross

21 counties across central Pennsylvania and the Lehigh Valley

Usually: no published timeline. What Capital publishes instead is an instruction not to schedule services with its members until you hold written notification that credentialing is complete and confirming your effective date. Plan the go-live off that letter, not off submitting. Pennsylvania has nothing that pays you for the gap
The packet: CAQH with Capital authorized, plus a provider data form, an eSOR enrollment form, a W-9, an Authorization for Third-Party Attestation and an EFT form
After execution: 90 days to enroll in electronic funds transfer, the portal and electronic remittances. No separate behavioral door here

UnitedHealthcare

Behavioral health goes through Optum, which publishes what it wants

Usually: 60 to 120 days from a complete application
Published need: MDs, DOs and RNs with prescriptive authority sought statewide, with doctoral and master’s level clinicians in a named set of roughly 27 counties. Also telemental health, medication-assisted treatment prescribers, Express Access providers who can see a patient inside five business days, and child and adolescent work. The clearest network need signal in the state
Two gates: an unrestricted Pennsylvania license and a CAQH ID before you start on Provider Express. And the Medicaid line runs in the Southeast zone only, not the statewide footprint it has elsewhere

Separate door: Optum Behavioral Health

Geisinger Health Plan

Behavioral health in plan, with a 60-day deadline pointed at you

Usually: no published clock, but an application left incomplete for 60 days is treated as voluntarily withdrawn and the process stops. A missing document is expensive here in a way it isn’t everywhere
Path: CAQH with Geisinger authorized, plus unrestricted licensure, DEA where applicable, and liability at the state licensure board’s minimum limits
Direct contract: behavioral health providers credential with GHP itself under its Other Licensed Practitioners criteria, and psychiatrists are exempt from the hospital privileges criterion
Ownership: Geisinger joined Risant Health on March 31, 2024. New owner, same Pennsylvania network

Aetna is usually next. It credentials behavioral health itself but routes it through a separate behavioral request rather than the medical form, and starting on the medical form loses weeks. Commonly 60 to 120 days. Cigna sits out of the opening set right now: Evernorth paused new individual and clinic behavioral health applications on June 1, 2026, facilities exempt, anything started earlier unaffected, and pointed everyone else at a revisit after September 1, 2026. That pause is national rather than a Pennsylvania decision. CHIP here is its own program with nine managed care organizations, and WellKids by PA Health & Wellness joined statewide in January 2026 in the first re-procurement since 2013. Medicare, Medicaid and CHIP work is scoped separately.

Carry a plan we didn’t list? Add it.

Philadelphia is its own behavioral health payer, and that catches practices on the city line constantly. Community Behavioral Health is a city-run nonprofit under the Department of Behavioral Health and Intellectual disAbility Services, covering Philadelphia County and nothing else. The county body above the MCO matters too: York/Adams HealthChoices, the Carbon/Monroe/Pike Program, the Northeast Behavioral Healthcare Consortium and the Lycoming/Clinton Joinder Board are all real contracting parties.

Then everything else on a member card. Community HealthChoices covers all 67 counties for older adults, adults with physical disabilities and dual eligibles, and behavioral health is carved back out of it to the same county MCO. Taft-Hartley union trusts across the Pittsburgh and Philadelphia markets are usually reached by joining a rented commercial network rather than by contracting with the fund, and the card may carry a TPA name you don’t recognize. You name the plan and we find the real route. The cheapest contract is the one you already hold.

What we need from you

Send these once and we can start.

You give us this in one intake. Then we fill out the applications. No passwords, no patient information, and nothing gets submitted until you’ve read it and signed.

The counties your patients actually come fromThe most important answer you give us here. Your county list decides which behavioral health MCOs you need, whether that’s one contract or three, and the order we open them in. Guessing costs months.
Your individual NPIType 1, plus the Type 2 if you bill under a group. Pennsylvania Medicaid needs both, because one identifies the rendering provider and the other identifies who gets paid.
Active Pennsylvania license and DEA certificateUnrestricted. Optum won’t let you start its application without an unrestricted Pennsylvania license, and Geisinger and Highmark both verify DEA as part of the file.
CAQH attested and each payer authorizedHighmark asks for global access rather than plan by plan, and Community Care treats an attestation as valid for only 180 days. You attest. We keep it current and never ask for your password.
Delegated PROMISe access and every service locationSo we can file without password sharing. Pennsylvania enrolls and revalidates per location, so a missing address is a missing enrollment. We want the mailing address on file too, because that’s where notices go.
Entity name, EIN and a signed W-9One per tax ID you bill under. Capital Blue Cross requires the W-9 inside its packet, and Highmark needs a billing practice, the assignment account, established before practitioners attach to it.
Current malpractice certificateGeisinger’s stated minimum is professional liability at the state licensure board’s minimum limits, and an expired certificate sitting in CAQH is a routine cause of delay.
Five years of work history and a current CVMonth and year, with any gap over six months explained. Highmark’s Certify intake asks for the CV as a PDF up front.

Separately, Pennsylvania may want the practice entity itself licensed, apart from your own clinical license, and it splits that across two departments. DHS, through OMHSAS, issues a certificate of compliance to psychiatric outpatient clinics under 55 Pa. Code Chapter 5200. The Department of Drug and Alcohol Programs licenses freestanding drug and alcohol treatment facilities under 28 Pa. Code Chapter 709, by activity, so one facility can hold licenses for several service types. Whether any of it reaches you turns on how the practice is set up and how it presents itself rather than on your credentials. We ask about your service mix at intake and flag it early if it looks like it could apply. We don’t tell you whether you need a license, we don’t publish the requirements, and we don’t file it. That conversation belongs with you and your own counsel.

How it works

You answer once. We do the paperwork.

You can buy online without booking a meeting. Nobody has to sell you anything first.

Buy the package

Published price and scope. No call needed.

One intake

Short and guided. It asks more only where your answers call for it.

We prepare everything

Your PROMISe enrollment, each behavioral health MCO application your counties call for, and every commercial application.

You review and sign

Read it, change anything, sign. Nothing goes out until you say so.

We submit and track

You see what’s done, what’s waiting on a payer, and when you can bill.

What we commit to

Tracking is included. Every package comes with Command Suite access, so you can see where each payer application stands, what we are working on, what is waiting on a payer, and what we still need from you. You are not left guessing between the purchase and the finish.

If something we delivered does not work the way we said it would, we fix it at no charge for 30 days after delivery, including one stabilization review. That covers our own work. A new request, another payer or provider, or a change of scope is quoted separately.

Built to keep working after we are done. Everything we set up is built for the practice you are growing into, not only the one you have today. When the engagement ends you own the accounts, the documentation, and the systems, and they keep running without us.

Questions we get

Pennsylvania credentialing questions

Which behavioral health plan pays me for a Pennsylvania Medicaid patient?

The one their county contracts with, not the plan on their physical health card. Behavioral health is carved out of HealthChoices in all 67 counties, and the county, or a multi-county alliance or joinder, subcontracts to a behavioral health MCO. Community Care covers 41 counties, Carelon 11, Magellan 7, PerformCare 7, and Philadelphia runs its own plan, CBH. Serve three counties and you may need two or three contracts, because each county program is contracted separately.

Should a psych NP take Highmark’s APP enumeration track?

Ask hard first. Enumeration adds an advanced practice provider to eligible Highmark networks for billing under their own NPI and skips credentialing, and CRNPs are on the Pennsylvania eligible list. It looks like the fast lane. But Highmark’s own guide says enumerated APPs aren’t listed in the provider directory and are reimbursed at a lower rate than fully credentialed providers. You can do everything right and end up invisible to patients while every claim pays less. We confirm the track before anything goes in.

How do I join UPMC Health Plan’s behavioral health network?

You don’t apply to UPMC. Community Care Behavioral Health contracts and credentials behavioral health for UPMC Health Plan commercial, UPMC for Kids CHIP, UPMC for Life Medicare and Complete Care D-SNP, and it’s separately the Medicaid behavioral health MCO for 41 counties. Its credentialing inquiry has you tick every applicable HealthChoices county program and every applicable UPMC product on one intake, so one correctly routed application can open Medicaid behavioral health in several counties plus commercial. Applying to core UPMC medical is the classic wasted month.

Is there a credentialing deadline in Pennsylvania?

No, and it’s worth being honest about that. 40 P.S. 991.2121 requires a Department-approved credentialing process, disclosed criteria, reporting at least every two years, and a written rationale on denial. 28 Pa. Code 9.761 adds recredentialing at least every three years. Neither sets a deadline for deciding your application, and neither creates a standard application or a state database. House Bill 544 would add timing requirements; it was referred to the House Insurance Committee on February 10, 2025 without moving.

Can I see patients while my application is pending?

Two carriers tell you in writing not to. Highmark says don’t see members or submit claims until you’re notified of acceptance. Capital Blue Cross says don’t schedule services with its members until you hold written notification that credentialing is complete and confirming your effective date. Pennsylvania has no back pay rule if you go early. Plan the go-live off the approval letter, not the submission date.

Do I need all three Blue plans in Pennsylvania?

Depends where you practice. Highmark runs as Highmark Blue Cross Blue Shield in the west and northeast and as Highmark Blue Shield in the center and southeast. Independence Blue Cross holds the Blue Cross license for Bucks, Chester, Delaware, Montgomery and Philadelphia. Capital holds it for 21 central and Lehigh Valley counties. Because the two licenses are split in the center and southeast, covering the full in-state Blue population there usually means Highmark Blue Shield plus either Capital or Independence. Regional licensees inside one state, not a contract per state.

How often does Pennsylvania Medicaid revalidation come around?

Every five years, and per service location rather than per provider. DHS puts the reminder at the top of every Medical Assistance Bulletin it issues, including March 19, 2026: log into PROMISe, check the revalidation date on each location, and file at least 60 days before it. A practice that has added or moved a site can carry several dates at once, and a lapse on one shows up as claims from that address no longer paying.

I’m enrolled in PROMISe. Why can’t I bill a Medicaid plan yet?

Enrolling and joining are two different steps. DHS says plainly that enrolling in Medical Assistance doesn’t put you in an MCO network, that you contact the plans yourself, and that some networks may be closed. It runs the other way too: under 42 CFR 438.602(b) and 438.608(b) you have to be enrolled in Medical Assistance to be a network provider for any Pennsylvania Medicaid managed care organization, behavioral health MCOs included. And there’s no uniform behavioral health application.

Do you need my CAQH password?

No, and we won’t ask. We’re added as an authorized practice manager, which lets us keep your practice data current and authorize each payer. You complete and attest your own profile and you sign your own paper applications. Two Pennsylvania wrinkles: Highmark asks for global access rather than authorizing plan by plan, and Community Care treats an attestation as valid for only 180 days.

Keep reading

Pennsylvania PMHNP scope of practiceWhat Pennsylvania allows you to do, which is a separate question from who pays you.
Ohio payer enrollmentOne state application credentials you for all seven Medicaid plans, with a 90-day clock on commercial.
New York payer enrollmentMedicaid managed care is plan by plan, and the entity licensure question is unsettled for a PLLC.
West Virginia payer enrollmentHighmark runs there too, on a different clock from the one it uses in Pennsylvania.
Opening your own practiceEntity, identifiers, payers, EHR and billing setup.
Adding a provider to your clinicFirst-time credentialing into contracts you already hold.
Changing your entity or tax IDMoving panels without breaking the money.
All 51 state guidesEvery state’s Medicaid path, plan roster and credentialing rules.

Ready to get billable in Pennsylvania?

Start the intake, tell us your counties, and we’ll map your PROMISe enrollment, your behavioral health contracts and your commercial path. Most people never need a call.

See packages and pricing

Where this comes from

Pennsylvania Department of Human Services, Behavioral HealthChoices: the five behavioral health MCOs, the counties each serves, and the County Option and State Option split verified July 26, 2026
Pennsylvania Department of Human Services, Medicaid Managed Care Directory updated June 2026: the five zones and the county primary contractors verified July 26, 2026
Pennsylvania Department of Human Services, PROMISe provider enrollment: application types, the Application Tracking Number, rendering versus group billing, and the statement that Medicaid enrollment is not MCO network enrollment verified July 26, 2026
Pennsylvania DHS Office of Medical Assistance Programs: the Medical Assistance Bulletin of March 19, 2026 on five-year revalidation per service location, and Bulletin 99-19-06 on 42 CFR 438.602(b) and 438.608(b) verified July 26, 2026
Pennsylvania Department of Human Services credentialing standards: each behavioral health MCO runs its own process, with no uniform behavioral health application verified July 26, 2026
Pennsylvania Department of Human Services, January 8, 2026: WellKids by PA Health & Wellness joins CHIP statewide, the nine-MCO network verified July 26, 2026
Pennsylvania Statutes, Pennsylvania Code and the General Assembly: 40 P.S. 991.2121 with no decision deadline, 28 Pa. Code 9.761 on three-year recredentialing, and House Bill 544, not enacted verified July 26, 2026
Highmark, Provider Guide to Credentialing for Pennsylvania, West Virginia and New York: APP enumeration without directory listing and at lower reimbursement, and the Pennsylvania APP-eligible list verified July 26, 2026
Highmark, professional credentialing and the Certify platform effective November 3, 2025: CAQH global access, the 45-day goal, the six-week early submission limit, and no members or claims before acceptance verified July 26, 2026
Independence Blue Cross, professional credentialing and the April 2026 Behavioral Health Provider Manual: the Practitioner Participation Form, the 30-day DocuSign window, and AJ modifier billing verified July 26, 2026
Capital Blue Cross, join our network: the 21-county area, the participation packet, no scheduling before written notice of the effective date, and 90-day EFT and portal enrollment verified July 26, 2026
Community Care Behavioral Health and UPMC Health Plan Provider Manual Chapter L: credentialing for UPMC commercial, CHIP, Medicare and D-SNP, the single county-and-product intake, contracted CRNP categories, and the 180-day windows verified July 26, 2026
Geisinger Health Plan credentialing criteria: an application incomplete for 60 days deemed withdrawn, liability at state board minimums, and the psychiatrist privileges exemption verified July 26, 2026
Optum Provider Express, Pennsylvania join our network: prescribers sought statewide, doctoral and master’s clinicians in a named county set, and the license and CAQH prerequisites verified July 26, 2026
Evernorth Behavioral Health on the June 1, 2026 application pause, plus Magellan of Pennsylvania and PerformCare on county coverage and the Medical Assistance enrollment requirement verified July 26, 2026

Written by Ryan Berg, founder of AdvanceAPractice. 16 years in healthcare revenue cycle and credentialing.

Facts on this page were verified July 26, 2026 and are next due for review October 19, 2026.

Payer programs, plans and timelines change. Everything here carries a verification date and gets re-checked on a review cycle; this record is next due for review on October 19, 2026. Approval and effective dates are controlled by the Commonwealth, the counties and each payer, and credentialing commonly runs 60 to 120 days per payer. This page covers payer operations. It isn’t legal, tax or scope of practice advice.