Agreements can also be mailed to the following address: We are pleased that you have decided to join the D`Aetna Better Health of Pennsylvania supplier network. A strong supplier network is an essential part of improving our members` health outcomes. The Office of Developmental Programs (ODP) issued, on Tuesday, January 14, 2020, a notification regarding the new provider agreement for participation in the Pennsylvania Consolidated Waiver, Person/Family Directd Support Waiver, Adult Autism Waiver and Community Living Waiver («Waiver Programs»), which are considered a national «provider agreement» between Waiver and ODP funded service providers, Department of Human Services, 1999. as a Pennsylvania State Medicaid Agency with effect from January 1, 2020. As of August 1, 1, 2018, the provider may need to call the Office of Medical Assistance Programs, Provider Enrollment at 1-800-537-8862 to request a paper application when the PDF version of the application is no longer published on the DHS Provider Enrollment website. Paper applications continue to be accepted for processing. Types of vendor registration applications There are three types of logging applications for which a vendor must complete a full application. Please click on the corresponding navigation point on the left side of the page to launch a «new application», «Revalidation» or «Reactivation». For registration, suppliers can complete an online supplier registration application and provide all necessary supporting documents. These include providers who do not charge PA Medicaid or CHIP, but provide services to recipients. All applications are reviewed before making a listing decision based on federal and regional guidelines. Please keep copies of your application package.

You will receive a response after approval or rejection of your enrolment in PA Medicaid and/or CHIP. Supplier Application Fee The Social Security Act requires states to levy, where applicable, an application fee before executing a supplier agreement from a potential supplier or again. Full rules are available at 42 CFR 455, Subpart E – Provider Screening and Enrollment, Section 455.460. The Centers for Medicare & Medicaid Services (CMS) sets the amount of the application fee each year. For more information about fingerprint-based criminal background testing and the criteria used to assign a «high»risk» level provider, see the High Medical Assistance Bulletin. For CHIP providers, please contact your designated chip management body(ies). Existing participating vendor groups can continue to complete each vendor`s application if you want to sign up for other vendors. The request can be sent by email to MedicaidProviderRelations@aetna.com or by fax to 1-860-754-5435. To pay a registration fee, suppliers must register and re-validate via the electronic supplier registration application. Practices that are currently under contract with Aetna Better Health can now register new providers by filing an online application to initiate the process. The following table contains links to the corresponding vendor registration forms for each vendor type. Aetna Better Health of Pennsylvania and Aetna Better Health Kids` network of suppliers includes hospitals, physicians, specialists, operations centers, help service providers, and centers of excellence across the United States.

Suppliers may request an exemption from the registration fee. When an exemption is requested, the supplier is asked to submit documents (to be downloaded). CMS decides whether or not the exception is granted and transmits the information to the division. . . .