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 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 enrollment information for all FFS and Ordering, Referring, and Prescribing (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

It is a federal and state requirement to complete the revalidation process within 45 days of receiving notification of revalidation (launch letter). Providers should take the following steps to prepare for revalidation:

• Validate their information and ensure that it’s accurate per MassHealth regulations to support revalidation.
• Identify a primary and secondary person in their organization who will coordinate the revalidation for the provider.
• Make sure that person has access to the MassHealth Provider Online Service Center (POSC).
  • If that person does not have access to the POSC, they must contact the provider’s primary user.
  • 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].
• 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 now acceptable forms of signature.

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 nonbilling 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 (launch letter):

• Providers must complete the online attestation and submit a completed Federally Required Disclosure form, and any other requested documentation, within 45 days.
• If the requested information is incomplete or there is no response, the provider’s designated contact person(s) will be notified.
• 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.

Revalidation Outcomes

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

• Providers who successfully complete revalidation will receive a confirmation letter. The letter will be sent to their primary Doing-Business-As (DBA) address.
• 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 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

The primary and secondary contacts for a provider may correspond with a MassHealth Revalidation representative by email ([e-mail]) for any concerns throughout the process. MassHealth does not recommend calling MassHealth Customer Service to confirm the status of revalidations.

Date published:	January 22, 2024