Revalidation for Fee-for-Service (FFS) Providers

MassHealth providers need to revalidate their information at least every five years. This page explains the process for Fee-for-Service (FFS) Providers.

For Ordering, Referring, and Prescribing (ORP) revalidation, go here.

Background

Section 6401 of the Affordable Care Act established a requirement for Medicare and Medicaid to revalidate provider file information for all FFS and Ordering, Referring, and Prescribing (ORP) providers, regardless of provider type. MassHealth providers need to validate their provider file information at least every five years.

As part of the required revalidation process, MassHealth must revalidate provider file information of all active providers and site locations. Other information, such as a Federally Required Disclosures Form (FDRF), may be required. See Section 6401 of the Affordable Care Act, 42 CFR 455.414 and 42 CFR 455.104(c)(l)(iii).

Revalidation Preparation

It is a federal and state requirement to complete the revalidation process within 45 days of receiving notification of revalidation via email. Providers should take the following steps to prepare for revalidation.

• Identify a primary and secondary person who will coordinate and complete the revalidation for the provider.
• Validate their information and ensure that it’s accurate per MassHealth regulations to support revalidation.
• If the provider is not actively enrolled in Medicare, they must complete the attestation on the MassHealth Provider Online Service Center (POSC). The person identified above should make sure that they have access to the POSC for the provider being revalidated
  • If that person does not have access to the POSC for the provider being revalidated, they must contact the provider’s primary user who manages access.
  • If they don’t know who their primary user is, they may contact customer service at [phone], TDD/TTY: 711.
  • If they need to assign a new primary user for that provider, they must email an Existing Provider Modification Data Collection Form [POSC-DC-PM] with the administrator’s information to [e-mail]. The form can be found on Mass.gov.  

Providers who do not want to continue their participation in the MassHealth program, and therefore do not want to complete revalidation, are required to submit written notice to MassHealth with the requested termination date of their participation. Massachusetts state law requires certain types of providers to participate as Ordering, Referring, and Prescribing providers to obtain and maintain state licensure. Go here for more information.

Revalidation Process

Providers and their designated contacts for the revalidation process should be aware of the following requirements after receiving their notification of revalidation via email, which will include all necessary instructions. 

• All correspondence will be communicated from MassHealth to the primary and secondary user(s) designated to complete the Revalidation for the provider.
• Non-Medicare providers must complete the online attestation and submit a completed Federally Required Disclosure form (FRDF), and any other requested documentation within 45 days.
• Providers will receive instructions in the notification of revalidation on the method by which they should submit the FRDF, electronic pre-populated FRDF, or secure document upload for entity FRDFs.
• If the requested information is incomplete or there is no response, the provider’s designated contact person(s) will be notified of possible sanctions or termination.
• Any individual (other than the primary or secondary contact person who has been designated to complete the revalidation for the provider) inquiring about the status of the provider’s revalidation must consult the primary or secondary contact who has been designated for revalidation to inquire about the revalidation.
• For any requested documents, a provider’s signature for an individual provider, or an authorized agent for an entity provider, is required. Adobe, Adobe Sign, and DocuSign are acceptable forms of electronic signature.

Revalidation Outcomes

The following revalidation outcomes depend on the completion of the process:

• Providers who successfully complete revalidation will receive a confirmation letter that will be sent to their primary Doing-Business-As (DBA) address. The primary and secondary(s) will receive a copy of the letter via email.
• Providers who fail to complete revalidation will be subject to termination from the MassHealth program in accordance with federal and state guidelines. Terminated providers will also receive a letter from MassHealth to their primary DBA address. The primary and secondary user(s) will receive a copy of the termination letter via email.
• Eligible providers who fail to revalidate may be impacted when renewing licenses from their respective licensing boards.
• Any claims that a provider would have ordered, referred, or prescribed while terminated would impact the payment of another MassHealth provider’s claims.

Contact

The primary and secondary contacts for the provider should refer to the email received at the beginning of Revalidation to correspond with MassHealth for any questions or concerns.

Date published:	January 22, 2024
Last updated:	February 18, 2025