Pennsylvania Medical Enrollment Contest Form is a document used to register for a contest that provides assistance with medical enrollment in Pennsylvania. It requires applicants to provide personal information such as name, address, phone number, date of birth, and Social Security Number. The form also requires a signature from the applicant in order to become eligible for the contest. There are three types of Pennsylvania Medical Enrollment Contest Forms: individual, family, and senior. The individual form is used for individuals who are applying for medical assistance on their own. The family form is used for families who are applying together. The senior form is used for seniors who are applying for medical assistance.
Pennsylvania Medical Enrollment Contest Form
State:
Pennsylvania
Control #:
PA-SKU-0735
Format:
PDF
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Description
Medical Enrollment Contest Form
How to fill out Pennsylvania Medical Enrollment Contest Form?
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FAQ
Telephone: Call the Consumer Service Center for Health Care Coverage at 1-866-550-4355. In-Person: You can contact your local county assistance office (CAO). On Paper: You can download an application and send to your local CAO. If you need help completing the application form, a CAO staff member can help you.
Alternatively, you may also contact the Provider Service Center at 1-800-537-8862 to inquire on the status of claims.
Q: WHAT IS THE PROMISe ID? A: The PROMISe, or Provider Reimbursement and Operations Management Information System, ID is an identification number issued by the Pennsylvania Department of Human Services (Department or DHS).
1-800-537-8862 Hours of operation: Monday?Friday, 8 a.m.- p.m.
To choose or change your plan, visit .enrollnow.net or call PA Enrollment Services at 1-800-440-3989 (TTY 1-800-618-4225).
1-800-537-8862 Hours of operation: Monday ? Friday, 8 a.m.AM - p.m.
You may contact Provider Enrollment by calling 1-800-537-8862.