Search For:

The Department of Medical Assistance Services (DMAS) is clarifying its provider enrollment procedures, effective July 1, 2025, to ensure alignment with current program policy as outlined in Chapter 2 of all DMAS program manuals.

These updates will immediately impact:

• Start and end dates of program participation

• License-based disenrollment processes

Historically, DMAS allowed a 90-day grace period following license expiration before terminating a provider’s enrollment agreement. Beginning July 1, 2025, this grace period will no longer be available as this causes a delay in providers having the appropriate enrollment and consequently, claims are affected by this delay.  Beginning July 1, 2025, this grace period will no longer apply. All new or returning providers will now be enrolled in the DMAS provider system, known as PRSS, based on the month they apply or request reinstatement after any lapse in PRSS enrollment participation.

To be eligible for reimbursement from DMAS and its contracted entities including MCOs, all providers who furnish, order, or prescribe items or services must ensure that the provider’s:

• Enrollment is current and active for all service locations and provider types,

• Services provided and billed align with the PRSS enrolled provider type and specialty,

• Licensure and certification is active in PRSS for the provider’s type and specialty,

• Services are billed as rendered, under the rendering provider’s NPI, and 

• Claims satisfy all requirements for billing, rendering, servicing, ordering, referring, and prescribing providers.

Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS in the correct provider type and specialty for the types of services billed. As a reminder, courtesy notices are sent 90, 60, and 30 days prior to license expiration to help support continuous enrollment. 

Additional information on how to verify and update provider enrollment and license information in PRSS is provided below, including helpful contact information for any related questions or concerns.