Pharmacist Provider Status Recognized by Medicaid: Building the Framework for Billing
Authors: Stacey Grassi, Daniel Longyhore and Leeann Webster
On March 1, 2024, Pennsylvania State Medicaid announced the inclusion of pharmacists as providers, allowing them to bill and be reimbursed for patient visits and other services.
This milestone follows several years of collaboration with the Pennsylvania Department of Human Services, with Geisinger’s vice president of ambulatory care services, Gerard (Jerry) Greskovic, serving as a key driver of this advancement. This recognition marks a significant achievement for pharmacists.
Becoming credentialed providers with a health plan is a complex process involving multiple critical steps and a broad team of stakeholders. Geisinger’s strong support of pharmacy services enabled its pharmacists to become one of the first health system–based pharmacy teams to enroll and begin billing for services through Pennsylvania Medical Assistance.
Geisinger Pharmacy leadership, in collaboration with revenue management, credentialing, professional billing, compliance and other departments, developed a process to facilitate pharmacist enrollment.
The initiative began with Medication Therapy Disease Management (MTDM) pharmacists embedded at community medicine clinics who manage patients with chronic diseases.
This group was selected because an existing billing process for patient visits was already in place. Each pharmacist registered for a PROMISe™ ID provider number, which verifies enrollment with the state to render Medicaid-covered services. Staff then created profiles with the Council of Affordable Quality Healthcare, a repository allowing providers to store professional information for health plans to access during credentialing. Pharmacists are required to review and attest to the accuracy of their profiles every 90 days. Each pharmacist also attended a new provider orientation session led by the revenue management team.
Finally, staff worked closely with Geisinger’s corporate insurance team to ensure certificates of insurance were on file.
Pharmacy leadership collaborated with staff to update progress notes, ensuring the inclusion of appropriate language and time attestation phrases.
On Sept. 23, 2024, this monumental effort went live, with the majority of MTDM pharmacists billing Medicaid for services. To support seamless enrollment of new hires, an automated process was developed that incorporates communication among hiring managers, revenue management, credentialing and corporate insurance. As of August 2025, the MTDM program bills an average of 2,000 Medicaid claims per month and receives a higher reimbursement rate than was possible before pharmacists were recognized as billable providers. Pharmacists working in the MTDM Specialty space and retail pharmacies are next to be enrolled and begin billing Medicaid.
