Provider Enrollment & Credentialing FAQ

Guidance for Providers enrolling or credentialing with MassHealth.

Please refer to the Frequently Asked Questions below to address any questions or concerns about MassHealth provider enrollment and credentialing. MassHealth also encourages prospective or existing providers to review their applicable regulations and provider manuals, which outline program requirements and provider expectations. Regulations can be found on the MassHealth and EOHHS Regulations page, and manuals can be found on the MassHealth Provider Manuals page. 

Applying to be a MassHealth Provider

How do I apply to be a MassHealth provider?

All providers wishing to enroll with MassHealth should refer to Apply to become a MassHealth Provider for information about enrollment requirements and how to submit an application request.

Who is required to apply to become a MassHealth provider?

If you intend to participate within a group practice, you must be enrolled as a Fee for Service (FFS) provider and linked to the groups where you will practice. Any individual who intends to bill MassHealth directly, and is practicing independently, must also be enrolled as FFS.

All other individual providers that meet the Ordering, Referring, and Prescribing (ORP) criteria are required to participate as ORP in the MassHealth program. This is a condition of obtaining and maintaining your license to practice in Massachusetts.

All entities and group practices must enroll at each service location in MassHealth if members are seen at those locations. Non-billing sites, or sites that conduct billing through a main billing location, must also be enrolled in the program. You should not enroll administrative offices.

Enrolling each location allows for each location to be discovered by members in the MassHealth provider directory.

If you intend to join the Primary Care Clinician (PCC) Plan, you must first be enrolled as a Fee for Service provider, in alignment with program requirements. Please refer to Apply to become a PCC on Mass.gov for more information. 

How do I know that I have submitted a complete application?

You should refer to the checklist that was included in your application package from MassHealth to confirm that you have received and completed all forms. You should verify that all signatures and dates were provided, and all required fields are completed.

Please note: forms should only be signed at the time of submission. Once signed, forms cannot be accepted after 90 days. Only request applications as needed to ensure you have the appropriate version and your supporting documentation is current.

How do I know the status of my application?

You can verify the progress of your application by using Self-Service Tools for MassHealth Providers. You can search for your application using the Application Tracking Number (ATN) that was provided when MassHealth received your application or your National Provider Identifier (NPI). The status of your application is subject to change throughout the process; see below for application processing timelines.

How long does MassHealth take to process my application?

MassHealth has a 60-day timeline to process applications. However, a complete application submission will generally be processed within 30 days.

If your submitted application is incomplete, a representative from MassHealth will reach out to the contact person listed on the application. If the application is approved, a welcome letter will be sent to the service location(s) address listed on the application. Please allow sufficient mailing time to receive the letter.

You can also verify the progress of your application by using Self-Service Tools for MassHealth Providers. You can search for your application using the Application Tracking Number (ATN) that was provided when MassHealth received your application or your National Provider Identifier (NPI).

Once enrolled, the primary user for the provider may also access the welcome letter under the specific Provider ID Service Location (PID/SL) on the Provider Online Service Center (POSC).  Welcome letters are available on the POSC under the provider’s PID/SL for any providers enrolled since May 9, 2009. Group practices will not be able to see the Welcome Letter for individuals linked to their group under their group PID/SL.

Self-Service Tools for MassHealth Providers can also be used to verify a provider’s enrollment status within MassHealth, including their effective date in the program, by searching using their PID/SL, NPI, or FEIN.

For any outstanding questions, please contact MassHealth Customer Service at [phone], TTY/TDD: 711 or [e-mail].

Provider Online Service Center (POSC)

What is the MassHealth Provider Online Service Center (POSC)?

The Provider Online Service Center is a website that gives you the tools to effectively manage your business with MassHealth.

What is a MassHealth ID? How is it utilized?

All individuals, entities, or group practices enrolled in MassHealth have a Provider ID/Service Location (PID/SL) that is unique to the individual/provider type/service location. Utilizing a PID/SL in place of other identifying information, such as an NPI, will ensure a better experience working with MassHealth.

All MassHealth providers should maintain adequate documentation and records, such as their MassHealth PID/SL, in accordance with MassHealth Regulations 130 CMR 450.205.

What is a primary user for the Provider Online Service Center?

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. The primary user oversees changes for a  specific PID/SLs.

Each organization has only one Primary User and one Backup Primary User assigned to manage access to their information in the POSC. Providers should validate that the correct Primary Users are assigned to handle their information and make changes accordingly when a new Primary User should be assigned.

To confirm your assigned primary user, you may call MassHealth Customer Service at [phone]. If you have any further questions about the role of the primary users, please refer to the MassHealth Primary User Policy.

How do I assign a primary user for a new provider? An existing provider?

You must complete a Data Collection Form to establish a primary user when enrolling in MassHealth.  The Data Collection Form is included in the MassHealth enrollment package and on the checklist.  If you have further questions about how to establish a primary user, please refer to the MassHealth Data Collection Form FAQ.

Providers who are already enrolled may also refer to the Data Collection Form FAQ for any modifications.

Please note: Providers enrolled as ORP will not have access to the POSC and will not need to complete a Data Collection Form.

Once I’m enrolled with MassHealth, what services can I perform on the Provider Online Service Center (POSC)?

Enrolled providers can perform several services on the POSC. This includes, but is not limited to, the ability to check eligibility, submit claims, download MassHealth PDF remittance advices, and submit service authorizations. Please review MassHealth POSC Job Aids for additional information about navigating the POSC. 

Updating Information

How do I update my information within MassHealth?

Providers should refer to Maintaining MassHealth Provider File Information for specific instructions on updating their MassHealth profile. The process of submitting changes to information will differ depending on if a provider is fully participating or non-billing.

All providers should notify MassHealth at least 14 days prior to any change in their information. Failure to notify the Commonwealth in advance of the transaction can be considered a breach of contract, and result in fines and penalties in accordance with MassHealth Regulations 130 CMR 450.223(B).

How do I tell MassHealth I no longer want to be enrolled?

Any individual or service location that wants to suspend their participation in the program should notify MassHealth at least 14 days prior to the change. Failure to notify the Commonwealth in advance of the transaction can be considered a breach of contract, and result in fines and penalties in accordance with MassHealth Regulations 130 CMR 450.223(B).

As noted above, certain individual providers may be required to be enrolled to maintain their Massachusetts license.

Submit a letter confirming that you intend to terminate your relationship with MassHealth by faxing or mailing to the following address:

MassHealth Provider Enrollment
P.O. Box 278
Quincy, MA 02171

Fax: [phone]

LTSS providers, please contact the LTSS Provider Service Center at [phone] or [e-mail].

Dental providers, please contact the Dental Program Customer Service at (800)-207-5019.

I am a provider whose practice is outside of Massachusetts. Am I considered an out-of-state provider? Will I be reimbursed for services rendered?

It depends on your provider type; all applicants should refer to their specific provider type regulations. As noted above, if certain out of state individual providers are seeing MassHealth members, they may be required to enroll to order, refer, or prescribe for those members.

Out-of-state providers must also meet the conditions outlined in the Administrative and Billing Regulations at 130 CMR 450.233.

What do I do if my facility has undergone a change of corporate structure (merges, acquisitions, etc.)?

As part of your contract, you are required to notify MassHealth of any material changes in your relationship prior to the date of that change.

Please notify MassHealth in writing prior to the date of the change, include as much information about the transaction as possible, and offer a contact person. Failure to notify the Commonwealth in advance of the transaction can result in fines and penalties.

Please refer to MassHealth regulations 130 CMR 450.222, 130 CMR 450.223, and 130 CMR 450.301 for additional information. 

Date published:	November 12, 2024