Welcome, Providers

Public health emergency ending: What you need to know

As you know, the Pennsylvania Department of Human Services (DHS) was able to keep Medical Assistance (MA) coverage open for most people during the COVID-19 Public Health Emergency (PHE) even if they were no longer eligible for MA. DHS is now in the process of making sure that everyone who is receiving MA is still eligible by reviewing each person’s information.

What your MA patients need to do and how you can help

Latest updates

• Supporting documentation for prior authorization requests (PDF)
• Summer issue of Connections available online (PDF)
• Updated respiratory pathogen panel reimbursement policy (PDF)
• Risk Adjustment Program — new vendor, UST HealthProof (PDF)
• Save The Date! Improvements to the claims overpayment response process are on the way. June 17, 2025 (PDF)
• Statewide Preferred Drug List (PDL) changes, effective July 7, 2025 (PDF)
• Rite Aid pharmacy closure notice (PDF)
• Consider prescribing preferred adalimumab biosimilar products (PDF)
• 2025 HCBS Provider Claims Filing Instructions announcement (PDF)
• The 2025 Medical Provider Claims Filing Instructions are now available online. (PDF)
• 2025 Dental Supplement Announcement (PDF)
• Update: Formulary Changes (PDF)
• Provider Manual announcement (PDF)

Coronavirus (COVID-19)

Important information for providers regarding COVID-19

Important reminders

• J Code Prior Authorization Transition Update (PDF)
• Frequently Asked Questions — Service Authorizations, HHA eXchange, Reporting Critical Incidents, and Billing (PDF)