Credentialing by state / Pennsylvania
Nurse Practitioner Credentialing in Pennsylvania
Enrollments are billed 50% at the start and 50% at submission; everything else 100% at the start.
| NP practice environment | Reduced Practice (AANP) |
|---|---|
| Licensing authority | The Pennsylvania board of nursing, with physician collaboration or supervision required |
| Medicare contractor | Novitas Solutions, jurisdiction JL |
| Medicaid | Pennsylvania Medical Assistance, enrolled through PROMISe |
| Medicaid managed care | 7 plans, 2,738,844 members (2024) |
| Blue Cross Blue Shield plan | Independence Blue Cross, Highmark Blue Cross Blue Shield and Capital Blue Cross |
Pennsylvania Is a Reduced Practice State
The American Association of Nurse Practitioners classifies Pennsylvania as reduced practice: state law requires a career-long regulated collaborative agreement with another health provider for the NP to provide patient care, or limits the setting of one or more elements of NP practice. 12 of the 50 states and DC have that classification, and they are where NP applications most often stall on agreement paperwork.
For credentialing, reduced practice means the collaborative agreement is part of the file. Expect Pennsylvania Medical Assistance and most commercial plans, including Independence Blue Cross, Highmark Blue Cross Blue Shield and Capital Blue Cross, to ask for the agreement itself, the collaborating physician's name and NPI, and in some cases the physician's signature or attestation. The CAQH (DataSpring) profile has a section for the collaborating or supervising practitioner, and an empty section is one of the most common reasons a Pennsylvania NP application is returned.
Medicare does not ask for the agreement on the CMS-855I, but its NP rule (42 CFR 410.75) requires that you meet Pennsylvania's collaboration requirements, so the agreement has to be in force before the first claim to Novitas Solutions. If the collaborating physician changes, update CAQH (DataSpring) and notify every plan, since an agreement on file that has lapsed can trigger a recredentialing review.
Pennsylvania Medical Assistance Managed-Care Plans for NPs
After the state enrollment, each managed-care plan credentials you as its own application. The largest in Pennsylvania by 2024 enrollment:
- Vista Health Plan (AmeriHealth Caritas Pennsylvania and Keystone First): 990,564 members, owned by Independence Health Group
- UPMC Health Plan: 713,760 members
- Geisinger Health Plan: 428,376 members
See all 7 plans.
Neighboring States
If you practice near the border or by telehealth, the rules change at the state line: Delaware is full practice, Maryland is full practice, New York is full practice. New Jersey, Ohio, West Virginia share Pennsylvania's classification.
- Delaware NP credentialing (Full Practice)
- Maryland NP credentialing (Full Practice)
- New Jersey NP credentialing (Reduced Practice)
- New York NP credentialing (Full Practice)
- Ohio NP credentialing (Reduced Practice)
- West Virginia NP credentialing (Reduced Practice)
The full NP checklist, the entity decision and where applications stall are in our nurse practitioner credentialing guide. For Medicare, Medicaid and commercial plans for every clinician type in the state, see credentialing in Pennsylvania.
Questions Pennsylvania NPs Ask
Do Pennsylvania nurse practitioners need a collaborating physician to get credentialed?
Yes in practice. AANP classifies Pennsylvania as reduced practice, and Pennsylvania Medical Assistance and most commercial plans ask for the collaborative agreement and the physician's name and NPI with the application.
How does a Pennsylvania NP join Pennsylvania Medical Assistance?
Enroll with the Pennsylvania Department of Human Services through PROMISe. Most Pennsylvania Medical Assistance members are in managed care (2,738,844 enrolled across 7 plans in 2024), so after the state enrollment is active, each plan you want, such as Vista Health Plan (AmeriHealth Caritas Pennsylvania and Keystone First), UPMC Health Plan, Geisinger Health Plan, credentials you separately.
Can an NP licensed in Pennsylvania see patients in a neighboring state?
Only with a license from that state, and each state's practice rules apply to the patients there. Delaware is full practice; Maryland is full practice; New Jersey is reduced practice; New York is full practice; Ohio is reduced practice; West Virginia is reduced practice. Payer enrollment is also per state, so seeing patients across the line means a separate Medicaid enrollment and separate commercial applications there.
What does PECS charge a Pennsylvania NP?
CAQH (DataSpring) profile build $500; Medicare enrollment $500; Pennsylvania Medical Assistance enrollment $500; each commercial application, including Independence Blue Cross, Highmark Blue Cross Blue Shield and Capital Blue Cross, $200 per provider. Enrollment services bill 50% at engagement and 50% at submission.
Answers cover PECS services, prices and process. For legal, tax or clinical questions please consult a professional.
Sources: American Association of Nurse Practitioners, State Practice Environment (updated May 2026); KFF, Medicaid MCO Enrollment by Plan and Parent Firm, 2024. Practice classification is AANP's; confirm current rules with the Pennsylvania board of nursing. Updated October 7, 2026.