How to Become a Medicaid Waiver Provider in Pennsylvania

Pennsylvania runs on two clocks, and both are unforgiving. The first is the orientation certificate: your Certificate of Completion from ODP's required applicant orientation expires if you are not qualified within 120 days of the date on it, and a certificate older than 120 days cannot be used to qualify. So do not take orientation until you can move on the rest. The second is the requalification calendar. A new provider must be requalified by the end of the fiscal year following its initial qualification date, after which it becomes an Existing provider on a three-year cycle keyed to the last digit of its MPI number. Existing providers must submit their qualification documentation — form DP 1059 and the Provider Qualification Documentation Record with supporting evidence — by March 31 of the year requalification is due, because the administrative entity has to designate you qualified in HCSIS by its own April 30 deadline. On May 1, sixty days before the June 30 end date, an unqualified provider's status flips to Expiring; on July 1 it becomes Expired.

Complete ODP orientation, self-assess against the standards, submit the DP 1059 and Provider Qualification Documentation Record to your AE, get qualified inside 120 days, then enroll in PROMISe with the approved DP 1059 attached.

Application system: PROMISe provider enrollment

1. Register for and complete ODP applicant orientation

   Registration runs through the Applicant Orientation Registration page. Start the rest of the process immediately afterward — the certificate is only good for 120 days.

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2. Complete the self-assessment against ODP standards

   Qualification turns on demonstrating compliance through the self-assessment plus validation of your documentation, policies, and procedures.

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3. Submit the DP 1059 and Documentation Record to your AE

   The DP 1059 and the Provider Qualification Documentation Record, with all required supporting documentation, are what the administrative entity reviews. The Documentation Record itself contains the instructions and qualification requirements.

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4. Get qualified within 120 days of the orientation certificate

   The AE reviews the materials and determines whether the qualification standards are met, adding the qualified specialties to your HCSIS Provider Qualification Status screen.

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5. Enroll in PROMISe with the approved DP 1059

   Once qualified, the approved DP 1059 is uploaded with the electronic enrollment application and all required supporting documentation. The ODP enrollment team then records qualification dates according to when each specialty is effective in PROMISe.

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Pennsylvania does not publish these in a form we could verify, so we have not guessed at them. Ask directly — and if an answer here would help other providers, tell us and we will add it with its source.

• Which administrative entity is assigned to you, and what does it expect beyond the DP 1059 and Documentation Record?

  Ask: Your assigned ODP administrative entity

• Is there an enrollment fee for your PROMISe provider type, and what screening level applies?

  Ask: PROMISe provider enrollment

• What background checks and staff training does Chapter 6100 require for the services you intend to deliver?

  Ask: Your assigned ODP administrative entity

• Is ODP currently qualifying new providers for your service specialties and region?

  Ask: Your assigned ODP administrative entity