Pennsylvania Medicaid EVS: Verify Eligibility and the BH-MCO in PROMISe
In Pennsylvania the eligibility check does double duty for behavioral health: it confirms Medical Assistance coverage and tells you which BH-MCO to bill, because behavioral health is carved out by county. An ACCESS card alone proves neither.
Short answer
Verify Pennsylvania Medical Assistance eligibility through the PROMISe Eligibility Verification System: web checks in the PROMISe provider portal, phone at 800-766-5387, or batch 270/271 transactions. For dates of service within two years, the response includes eligibility segments, the MCO Physical and MCO Behavioral plan names, codes, and phone numbers, and third-party liability. DHS says not to rely on an ACCESS card and to check EVS every time you provide services.
Where to check
| Method | What it is |
|---|---|
| PROMISe provider portal | Individual web interactive EVS requests at promise.dhs.pa.gov, a preferred method |
| Telephone | Individual EVS requests at 800-766-5387 |
| Batch 270/271 | ANSI X12 v5010 270/271, through certified software or DHS's free Provider Electronic Solutions software, a preferred method |
Sources: PA DHS Eligibility Verification Information and Provider Quick Tips #11, read October 2026.
What the response tells you
- Eligibility segments. Begin and end dates, eligibility status, category of assistance, program status code, and service program description.
- MCO Behavioral. The behavioral health managed care plan's name, code, and phone number, with eligibility dates: the BH-MCO you bill.
- MCO Physical and CHC. The physical health or Community HealthChoices plan, which is not who pays behavioral health claims.
- Third-party liability. Other coverage to bill first, a common source of denials.
What the check has to answer for behavioral health
Which BH-MCO covers the member on the date of service. A move to another county changes the BH-MCO, so a member seen for months can suddenly belong to a different plan. Eligibility will not tell you whether your clinician is credentialed with that BH-MCO or whether the service needs authorization. Plan-by-plan details: Community Care, Magellan, PerformCare, Carelon, and CBH Philadelphia.
Keep your own enrollment current
Pennsylvania requires every Medical Assistance service location to revalidate its enrollment every five years; check revalidation dates in PROMISe and apply at least 60 days ahead, per DHS's August 2026 bulletin reminder.
Verify at booking, then before each visit
Eligibility can change between booking and the visit, so check both times. Stable's AI receptionist verifies insurance during the booking call or text and books the patient with a clinician credentialed with their plan.
Related: the Pennsylvania Medicaid billing guide, insurance verification for behavioral health and eligibility denials.
Frequently asked questions
How do I verify Pennsylvania Medicaid eligibility?
Through the PROMISe Eligibility Verification System: the PROMISe provider portal, the phone line 800-766-5387, or batch 270/271 transactions.
How do I find a member's behavioral health MCO in Pennsylvania?
The EVS response includes an MCO Behavioral segment with the plan's name, code, phone number, and eligibility dates. That is the BH-MCO to bill.
Is an ACCESS card proof of eligibility?
No. Pennsylvania DHS says not to assume eligibility from an ACCESS card and to check EVS each time you provide services.
What is the Pennsylvania EVS phone number?
800-766-5387, per PA DHS, as of October 2026.
The right BH-MCO, before the first session.
See Stable check Pennsylvania eligibility and the member's BH-MCO during booking and match them to a credentialed clinician.
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