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FAQ for Provider Enrollment and Credentialing and PCC Plan

See below for provider enrollment and credentialing FAQs.



Frequently Asked Questions

When do I have to fill out a new W-9 form?

The State Comptroller requires that all entities receiving payments from the Commonwealth have a Form W-9 "Request for Verification of Taxation Reporting Information" on file. The W-9 form must be filled out when there is a change in the following.

  • Legal entity name (no TAX ID change)
  • Corporate legal entity name
  • Legal entity address (no TAX ID change)
  • Check or remit mailing address (no TAX ID change)

How are members assigned to a Primary Care Clinician (PCC)?

Members are asked to choose a PCC or Managed Care Organization (MCO); if no choice is made, the member is assigned to one based on the member's demographics.

How does a member change PCCs?

Members may select a new PCC by calling the MassHealth Customer Service Center at (800) 841-2900. A transfer to a different PCC becomes effective after one business day. MassHealth does not limit the number of times that a member can change PCCs or managed care providers (that is, from the PCC Plan to a Managed Care Organization, and vice versa).

If you are a PCC Plan provider who has a patient who returns to your practice even though you are not that member's PCC of record, please allow the member to call the Customer Service Center from your office to make a change in his/her PCC Plan assignment. This will help to ensure that you will be eligible to be paid for any services you may provide to the member in the future.

Why do claims deny for lack of PCC referral when the Eligibility Verification System (EVS) stated no referral required the last time I checked?

Enrollment in Managed Care is ongoing; verify eligibility prior to each service that you provide.

I am a MassHealth provider. Am I automatically enrolled as a PCC?

No. There is a separate application process for the PCC Plan and only specific provider types may enroll. They are:

  • Physician
  • Nurse Practitioner
  • Community Health Center
  • Outpatient Hospital
  • Group Practice

For more information, or to request a PCC Plan application, contact Provider Enrollment.

I am a practitioner providing services to members in a PCC group practice. If I leave this group, am I still a PCC provider?

No. You must enroll with another PCC group practice as a PCC provider, or enroll as an individual PCC provider.

I am a provider whose practice site is just over the border from Massachusetts. Am I considered an out-of-state provider?

It depends on your provider type. If you are a physician, your practice site may be as far as 50 miles outside of the Massachusetts border and you may apply to become a MassHealth provider. For more information, you can refer to the regulation specific to your provider type.

I am an out-of-state provider. Will I be reimbursed for services rendered?

Out-of-state providers MUST submit an application within 90 days of the date of service. Additionally, the service(s) provided must have been as a result of an emergency and the provider type eligible to enroll in MassHealth. For more information, refer to the regulation for your specific provider type. 

What do I do if my facility has undergone an acquisition change?

Please call Provider Enrollment and an Enrollment Specialist will assist you. It is very important to inform MassHealth of any acquisition change prior to the effective date of the change as it may have billing and payment implications that may require MassHealth to issue new provider numbers.

How do I know if my organization has undergone an acquisition change?

Some examples of changes that may be considered an acquisition change include a change in Tax Identification, licensure, and change of organizational structure.

If you are unsure or would like clarification regarding acquisition changes, please contact us and an Enrollment Specialist will assist you.

What is the Prospective Interim Payment (PIP) program?

View the frequently asked questions about (PIP).

Should I consider EFT/Direct Deposit?

EFT offers the following advantages over traditional reimbursement via paper check:

  • Timely access to funds
  • Reduced administrative burden
  • Eliminates lost, stolen, or misdirected checks