Section 6401 of the Affordable Care Act established a requirement for Medicare and Medicaid to revalidate enrollment information for all enrolled providers, regardless of provider type, under new enrollment screening criteria at least every five years. MassHealth will begin its revalidation initiative in March 2014.

This revalidation initiative will initially focus on those providers who were enrolled on or before March 25, 2011, and will be completed by March 24, 2016. Providers enrolled after March 25, 2011, will be revalidated on or before five years from the date on which they were initially enrolled.

As part of this required revalidation process, MassHealth must revalidate the enrollment information and, if needed, collect an updated Federally Required Disclosures Form from all enrolled providers. Other information may also be required. See Section 6401 of the Affordable Care Act, 42 CFR 455.414 and 42 CFR 455.104(c)(1)(iii).

About the Revalidation

  • MassHealth will select a number of providers each month for revalidation. We intend to revalidate providers by provider type.
  • MassHealth will mail a revalidation letter that includes links to important documents that require a “wet” signature and provider-type instructions to assist with the revalidation process. Providers will be required to return these documents to
    MassHealth Provider Revalidation Unit
    P.O. Box 121205
    Boston, MA  02112-1205
  • Providers must log onto the POSC to complete their revalidation.
  • Providers will have 45 days from the date of the revalidation letter to complete the revalidation process. Failure to complete revalidation in a timely fashion may result in sanctions. Such sanctions may include, but are not limited to, administrative fines and suspension or termination from participation in MassHealth. See 130 CMR 450.238 through 450.240.

MassHealth also plans to communicate with providers by

  • posting a list of provider types scheduled for revalidation on this MassHealth Provider Revalidation web page;
  • posting notices to the POSC;
  • partnering with the provider associations to disseminate the message;
  • face-to-face provider trainings;
  • webinars;
  • provider association trainings;
  • Massachusetts Health Care Training Forums (MTF);
  • remittance advice banner messages; and
  • Provider Association Forums (PAF).

Revalidation Preparation

Providers should take the following steps to prepare for revalidation.

  • Identify the person in your organization who will complete the revalidation.
  • Make sure that person has secure primary-user access to the POSC.
  • Identify the person in your organization who will complete the Federally Required Disclosures form pdf format of Federally Required Disclosures
txt format of pe-frd.txt for the entity.
  • If applicable, be prepared to have each individual provider sign the required forms, including the Federally Required Disclosures form.

Note: Providers who are in private practice and not affiliated with or employed by a group organization should follow the instructions for their provider type. These instructions will be included in the revalidation letter that MassHealth will mail to you.  

If you do not have access to POSC, you must submit a Data Collection Form (POSC-DC) pdf format of Data Collection Form [POSC-DC]
doc format of Data Collection Form [POSC-DC] with the administrator’s information. You can e-mail the completed form to providersupport@mahealth.net, fax it to 617-988-8974, or mail it to
MassHealth Provider Revalidation Unit
P.O. Box 121205
Boston, MA  02112-1205

Bulletins

MassHealth Provider Bulletins issued to support the revalidation of providers.

Job Aids

To comply with the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) requires all enrolled providers to revalidate their enrollment information every five years. MassHealth has created the following job aid to help its providers through this process on the Provider Online Service Center (POSC).

Group Practice Organizations

It is imperative that the group practice ensures that the individual practitioners linked to the group are accurate and current on the group’s MassHealth provider file.

Individual MassHealth practitioners who are enrolled as part of a MassHealth group practice organization must obtain an individual MassHealth provider number. Those providers who will not submit claims for payment under their individual national provider identifier (NPI) number must update their provider file with MassHealth to a “no pay” provider. A “no pay” status eliminates need for a Massachusetts Substitute W-9 and an Electronic Fund Transfer Enrollment/Modification form.

Important Reminder About Ongoing Provider Profile Maintenance

Providers should not wait until it is time to revalidate to notify MassHealth of changes. MassHealth regulations require that all providers notify MassHealth within 14 days of any change in any of the information submitted in the application. See 130 CMR 450.223(B).

To submit changes through the POSC, go to www.mass.gov/masshealth/providerservicecenter and click on the Manage Provider Information link, then on Maintain Profile and then on Update Your MassHealth Profile.

Frequently Asked Questions

Questions

If you have any questions about the information on the revalidation process, please e-mail your inquiry to providersupport@mahealth.net or contact MassHealth Customer Services Center at 1-800-841-2900.