MassHealth Data Collection Form FAQ

This page outlines the frequently asked questions related to MassHealth Data Collection (DC) Forms and subordinate user access.

Data Collection Forms

What is a Data Collection (DC) Form?

In general, a MassHealth Data Collection (DC) Form is used by provider organizations to assign a Primary User to a newly enrolled Provider ID/Service Location (PID/SL) or to modify the Primary User assigned to an existing PID/SL. Each DC form includes key information and instructions on how to complete the form. MassHealth has two provider DC forms:

1. Provider Enrollment DC Form PDF | Word
2. Existing Provider Modification DC Form PDF | Word

Both forms are available at mass.gov/RegisterMassHealthProvider.
 

What is the Provider Enrollment DC Form used for?

The Provider Enrollment DC Form can be used only to establish a Primary User for a new MassHealth PID/SL upon enrollment in MassHealth. The form must be submitted with your MassHealth provider enrollment application. Please submit the Provider Enrollment DC Form to MassHealth at the following address.

MassHealth Provider Enrollment & Credentialing
PO Box 278
Quincy, MA 02171-0278
Or fax: [phone]

If you have already established a Primary User for an existing PID/SL and want to change the Primary User information for that location, please complete the Existing Provider Modification DC Form at mass.gov/RegisterMassHealthProvider.

Please Note: MassHealth will accept the Provider Enrollment DC Form only at the PO Box and fax number above. If you are submitting an Existing Provider Modification DC Form, it must be emailed to [e-mail]. 

All required fields in the data collection form must be completed. Incomplete and handwritten forms will be rejected. Only one PID/SL per DC form will be accepted. No more than five separate DC forms per request will be accepted.

MassHealth will accept Adobe, Adobe Sign, and DocuSign as acceptable forms of electronic signature. Typed text of a signature is NOT acceptable. The Provider's signatory must be an authorized agent.
 

What is the Existing Provider Modification DC Form used for?

The Existing Provider Modification DC Form can only be used by existing MassHealth providers to modify the Primary User information for a PID/SL. These forms are used to:

• replace the current Primary User with a new Primary User;
  Please Note: If the name and/or the user ID of the existing Primary User is not found in MMIS, or the user ID is not submitted on the form, MassHealth will assign the Primary User role only to the new Primary User.
• update the email address of the Primary User (only if unable to edit online); or
• deactivate a Primary User for an organization.

All required fields in the data collection form must be completed. Incomplete and handwritten forms will be rejected. Only one PID/SL per DC form will be accepted. No more than five separate DC forms per request will be accepted.

MassHealth will accept Adobe, Adobe Sign, and DocuSign as acceptable forms of electronic signature. Typed text of a signature is NOT acceptable. The Provider's signatory must be an authorized agent.

Please submit the Existing Provider Modification DC Form to MassHealth at [e-mail].

If you are submitting a provider enrollment application and want to initially establish a Primary User for a brand-new service location, please use the Provider Enrollment DC Form at mass.gov/RegisterMassHealthProvider.

Please Note: MassHealth will accept the Existing Provider Modification DC Form only at the email address above. If you are submitting a Provider Enrollment DC Form, it must be mailed or faxed.
 

I’m a Long-Term Services and Supports (LTSS) provider. Where do I get the LTSS Data Collection (DC) form, and where should I submit it?

LTSS providers can get information about the LTSS Data Collection (DC) form, process, and submission instructions from the LTSS Provider Portal.
 

I am an enrolled dental provider with an oral surgery specialty. Do I need to submit a form to gain access to the Provider Online Service Center (POSC) to submit claims for covered oral surgery services that are reported via Current Procedural Terminology (CPT) codes?

Yes. If you are already enrolled in the dental program with a surgical specialty, you must complete and submit the DC form. Read MassHealth Oral Surgeon Enrollment for more information. Once you gain access to the POSC, you can submit claims for eligible covered services documented within the Oral Surgery section of Subchapter 6 of the Dental Manual.

I have submitted a DC Form request to MassHealth. What information should I expect to receive?

Upon receipt of any DC Form request, MassHealth will:

• evaluate the request;
• classify it as either a new enrollment or modification request; and
• issue an acknowledgement notification to the submitter that the request has been received. We will include an assigned ticket number that will be used to track your request through completion. It’s important to keep this acknowledgement and ticket number. You will need to reference it later to check the status of your request.

Once MassHealth processes your DC Form, you will be notified. If your request was processed successfully, you will receive one of the following messages from the EOHHS Virtual Gateway.

• Enrollment DC Form:  A new user ID has been created along with the credentials and sign-in procedures.
• Modification DC Form:  A modification has been made to your account.

If your modification request was not processed successfully, you will receive an email from us telling you what information is needed to successfully process your request. Please update the form and resubmit it to the same email address that sent the request.
 

How long will it take MassHealth to process my DC Form?

We’ll process your DC Form within five-to-seven business days from the day it’s received. Please allow a full seven business days to receive confirmation that your DC Form has been processed.
 

It’s been seven days and I still haven’t heard back from MassHealth about my DC Form. What should I do?

Please do the following.

• Pull up the email notification you received from us acknowledging that your DC Form request was received. Find the ticket number assigned to your request.
• Email us at [e-mail] to ask about the status of your request. Include the ticket number from your acknowledgment email.

We’ll respond as soon as possible. If you are not the individual that submitted the DC Form, please ask the submitter to forward the original email notification to you so that you can reference the date of submission and ticket number. We need this information to research the status of the request.

Primary User

What is a Primary User?

The Primary User is the person in your organization who is responsible for managing access to your organization’s data on the Provider Online Service Center (POSC).  This includes all information data entered or exchanged with MassHealth via the POSC and its connectivity methods, as well as the creation and deactivation of users’ accounts and password resets.
 

What is a subordinate User?

A subordinate User is any user who is NOT the Primary User for the organization but has a user ID to access the POSC.
 

What is the role of the Primary User?

The Primary User within each organization is responsible for managing users’ access to the organization’s information in the POSC. The Primary User must accurately maintain access to the POSC and ensure the following.

• Each user/relevant staff member within the organization is notified of the Primary User and back-up administrator, the role of the Primary User, and the organization’s protocols related to User ID access and password resets.
• Each person who requires access is assigned a unique User ID. Sharing User IDs is not allowed.
• Each user is told that they are responsible for the use of the User ID and must not share it with anyone else.
• User IDs for staff that no longer work for the organization, or affiliates that no longer perform functions on behalf of the organization, are promptly deactivated so that they can no longer view, submit, or receive information on behalf of your organization.
• Subordinates are linked only to the PID/SL that they are entitled to access or to perform POSC functions.
• Passwords are reset for subordinate users.
• Establish and maintain a quarterly, semi-annual, or annual review and alignment of all user access to safeguard the organization’s MassHealth information.
• The Primary User must NOT grant every single user full access to all POSC features.
• The Primary User must assign access to a POSC function only to those specific user IDs who need access to that POSC function to perform their jobs.

 

Why do I need to assign a Primary User to manage access to the POSC?

If you don’t assign a Primary User to manage access to your organization’s information and access is not properly maintained, the following could occur.

• Users who no longer work for the organization will continue to have access to the organization’s information and can execute POSC functions on behalf of the organization.
• Affiliates who no longer have a contractual relationship with an organization will continue to have access to execute POSC functions on behalf of the organization.
• Fraudulent services (claims, prior authorization, etc.) could be submitted on behalf of the organization and could lead to downstream fiscal and/or legal issues.
• Users could continue to leverage the organization’s information to perform unrelated activities to benefit themselves or other organizations.
   

Do I need to establish a backup Primary User?

Yes, the Primary User must assign at least one backup Primary User to perform Primary User responsibilities in the Primary User’s absence.  

Please Note: Do not assign all POSC permissions to all subordinate user IDs that you create. The Primary User must only assign access to a POSC function to a user who requires that access to perform their job responsibilities (e.g., submit claims). In addition to the Primary User, only the backup Primary User should have access to all POSC permissions, and only the backup Primary User may be granted access to the “manage subordinate accounts” function. Any other user ID that has access to the “manage subordinate accounts” function must be modified to remove it to ensure that no other user can modify user accounts for the organization.
 

How do I give others permission to perform functions on the POSC on behalf of my organization?

The Primary User can grant access to services by linking the user ID of staff within another entity’s organization to the appropriate PID/SL and assigning the POSC services that the user will be able to perform. The Primary User can also link an individual user who already has a User ID to a new provider by selecting the “Administer account” feature on the POSC. Please refer to the MMIS POSC Job Aids for additional details on User IDs.

Please Note: Do not assign all POSC permissions to all subordinate user IDs that you create. The Primary User must only assign access to a POSC function to a user who requires that access to perform their job responsibilities (e.g., submit claims). In addition to the Primary User, only the backup Primary User should have access to all POSC permissions, and only the backup Primary User may be granted access to the “manage subordinate accounts” function. Any other user ID that has access to the “manage subordinate accounts” function must be modified to remove it to ensure that no other user can modify user accounts for the organization.

User ID & Access Questions

I’m a subordinate user (not a Primary User or a Backup Primary User) and I can’t access certain services on the POSC. Whom should I contact for assistance?

Please contact the Primary User within your organization. The Primary User is the person who can grant you access.

Please DO NOT contact MassHealth Customer service to modify this information.
 

I need to update the information associated with my POSC User ID.  How can I update this information?

You can directly update the following information online via the “Manage My Account – Update Profile” feature within your Virtual Gateway account:

• Name (first/last)
• Email address
• Phone number
• PIN
• Date of birth

Please DO NOT contact MassHealth Customer service to modify this information. 
 

Should a subordinate user ever contact the Virtual Gateway  to resolve a user ID or POSC access issue?

NEVER. The subordinate user must contact the Primary User within your organization to resolve any POSC access issues. The Primary User can resolve the following issues.

• Password resets
• User ID deactivation
• User ID reactivation
• POSC access for your organization
• Access to perform functions on behalf of a provider

Please Note: The Virtual Gateway cannot reset passwords or any of the functions noted above for subordinate users. All subordinate users must contact the Primary User within your organization to resolve access issues.

The Virtual Gateway can reset passwords only for Primary Users.
 

My Primary User has either left the organization or I don’t know who the Primary User is. How can I identify that person?

Please contact the systems administrator within your organization or your administration office to obtain this information. If you are unable to identify an active Primary User within your organization, your organization may need to assign a new Primary User for that location. This can be done by completing the Existing Provider Modification Data Collection Form PDF | Word and submitting it to MassHealth at [e-mail].

Date published:	March 31, 2023
Last updated:	April 8, 2024