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MHCP Enrolled Providers PCA Provider Agency Enrollment Checklist
MHCP Data Privacy Notice (DHS-6287)
Your initial PCPO/PCA Choice application must include all items listed under Initial Application in this checklist. Owners, managing employees and qualified professionals are required to attend PCA agency training before completing the enrollment process. Any additional business sites/locations must also submit a complete application.
MHCP must review PCA agencies (including Medicare-certified/Class A-licensed agencies who provide PCA services) once every year for continued enrollment. MHCP will notify agencies of their annual review and its requirements. Providers have 30 days to submit required documentation. MHCP will not approve service authorizations or pay claims for services provided, if the annual review information is not submitted within 30 days of the notification.
At a minimum, MHCP will require the following at annual review:
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