Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth
	MassHealth
	
	All Provider Bulletin 160
	October 2006 



	TO:	All Providers Participating in MassHealth

	FROM:	Beth Waldman, Medicaid Director

	RE:	MassHealth Provider Recredentialing


MassHealth and	MassHealth is committed to ensuring the integrity of its provider network 
Recredentialing 	and to ensuring that MassHealth members have access to professionals who are in compliance with MassHealth-participation criteria and in good standing with licensing, certifying, and accreditation authorities, when applicable.  Up-to-date and accurate provider information is important to members, providers, and MassHealth to ensure accurate provider directories and appropriate referrals, timely payment of claims, and successful communication.  To confirm and update information on providers participating in MassHealth, MassHealth will recredential all providers over the next three years.  The recredentialing initiative will be managed by MassHealth Customer Service with the assistance of MedAdvantage, a credentials-verification organization.

	Every year, we will select a different one-third of the provider network to be recredentialed.  When you are selected, we will contact you with further information.


Recredentialing Process	Once selected for recredentialing, you will receive a MassHealth recredentialing package that you must complete and return within 30 days, along with any other requested documentation.  To reduce the administrative burden of recredentialing activities on individual providers, when possible, we will use and supplement the Integrated Massachusetts Application for Initial Credentialing/Appointment that was developed by private payers in Massachusetts.  Additionally, many of the fields on the application that you will receive will be prefilled, based on the information currently included in MassHealth’s provider file and the information supplied by MedAdvantage.  
Your timely response to the recredentialing application is essential to ensure your continued participation in MassHealth.  

After MassHealth Customer Service reviews your completed recredentialing package, you will be contacted for any necessary clarifications and to be advised about the status of your application.

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Communications	Throughout the recredentialing initiative, we will keep you informed of the process and how it affects you through letters, provider bulletins, Update newsletter articles, and remittance advice messages.  As always, please remember to check the MassHealth Web site at www.mass.gov/masshealth frequently, as it is a good source for the latest in MassHealth news and updates.
	We would like to thank you in advance for your support in this important process.


Reminder to Report	The recredentialing process does not replace your requirement to report 
Changes in Your	changes in your provider information or status to MassHealth in writing.
Provider Information 	
Promptly 	Some changes in information or status that you must report to MassHealth Customer Service before the effective date of the change include: 
* ownership;
* tax identification;
* licensure;
* organizational structure; and
* other credentials, such as certifications or qualifications that may affect your eligibility to participate in MassHealth.

All other changes must be reported to MassHealth within 14 days.  See MassHealth regulations at 130 CMR 450.223 for more information about provider contract requirements.

Send your updated information in writing to the address or fax number listed below.  Include your MassHealth provider number and tax identification number on all correspondence.  If you have any questions about the documentation that you should send, contact MassHealth Customer Service at the phone number or e-mail address listed at the end of this bulletin. 
MassHealth
Attn:  Provider Enrollment and Credentialing
P.O. Box 9118
Hingham, MA 02043
Fax:  617-988-8974


Questions	If you have any questions about the information in this bulletin, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 6179888974.

			MassHealth
			All Provider Bulletin 160
			October 2006 
			Page 2