Background
Section 6401 of the Affordable Care Act established a requirement for Medicare and Medicaid to revalidate enrollment information for all Fee-for-Service (FFS) and ORP providers, regardless of provider type. MassHealth providers need to update their enrollment screening criteria at least every five years.
As part of the required revalidation process, MassHealth must revalidate the enrollment information of all enrolled 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
Providers must complete revalidation according to federal and state requirements. Revalidation must be completed within the timeframe established in their initial email from MassHealth. MassHealth will send providers a confirmation request/survey to the current email address on file.
MassHealth requires the following:
- Confirmation of contact information for the provider or any parties that will handle revalidation on the provider’s behalf; and
- Validation that the provider’s information is accurate per MassHealth regulations to support revalidation.
Revalidation Process
Be aware of timeframe, points of contact, and validating information on the prepopulated revalidation form, including the disclosure section.
- After the provider responds to the survey, they will receive an email with a link to complete a prepopulated revalidation form within 30 days.
- If the requested information is incomplete or there is no response, the provider’s designated contact person(s) will be notified.
Revalidation Outcomes
The following revalidation outcomes depend on the completion of the process:
- Providers, or their designated contact(s), who successfully complete revalidation will receive a confirmation email.
- Providers who fail to complete revalidation will be subject to termination and removal from the MassHealth program in accordance with federal and state guidelines. Terminated providers will also receive a letter from MassHealth to their primary Doing-Business-As (DBA) address.
- 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
For any concerns throughout the process, please email a MassHealth Revalidation representative at mahealthrevalidation@maximus.com. MassHealth does not recommend calling MassHealth Customer Service to confirm the status of revalidations.
| Date published: | January 22, 2024 |
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| Last updated: | May 1, 2024 |