offered by

MassHealth Provider Revalidation

MassHealth providers need to revalidate their information at least every 5 years

Background

Section 6401 of the Affordable Care Act established a requirement for Medicare and Medicaid to revalidate enrollment information for all enrolled providers, regardless of provider type, under new enrollment screening criteria at least every 5 years. MassHealth began implementation of this requirement in March 2014.

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

About the Revalidation

MassHealth will select providers each month for revalidation based on their date of enrollment.

MassHealth will mail a revalidation letter that includes the following:

  • List of requirements
  • Links to important documents that need to be submitted
  • Required documentation that requires a "wet" signature that must be mailed to the address listed below.

MassHealth Provider Revalidation Unit
P.OBox 121205
Boston, MA 02112-1205

Documents that do not require a wet signature, such as the Federal Required Disclosure Form (FRDF), are not required to be mailed and providers are encouraged to submit these forms via the MassHealth POSC.

Providers will be required to do a self-attestation on the POSC if the provider is not enrolled in Medicare. Providers who are enrolled with medicare would only be required to submit an updated FRDF.

Providers will have 45 days from the date of the revalidation letter to complete the revalidation process. Failure to complete revalidation in a timely fashion will  result in sanctions. Sanctions may include, but are not limited to, administrative fines and suspension or termination from participation in MassHealth. See 130 CMR 450.238 through 450.240. 

Revalidation Preparation

Providers should take the following steps to prepare for revalidation.

  • Identify the person in your organization who will coordinate the revalidation for a specific provider (all documents requiring a provider signature must be signed by the provider)
  • Make sure that person has secure primary-user access to the POSC. 
    • If that person doesn't have access to POSC, submit a Data Collection Form (POSC-DC), below, with the administrator's information by 
      • Fax: (617) 988-8974
      • Mail: 
        MassHealth Provider Revalidation Unit
        P.OBox 121205 
        Boston, MA 02112-1205
  • Identify the person in your organization who will complete and sign the Federally Required Disclosures form, below, for the entity.

The Data Collection Form and the Federally Required Disclosures Form are below, in Additional Resources.

Additional Resources for

Group Practice Organizations

It is imperative that the group practice ensures that the individual practitioners linked to the group are accurate and current on the group's MassHealth provider file.

Individual MassHealth practitioners who are enrolled as part of a MassHealth group practice organization must obtain an individual MassHealth provider number. Those providers who will not submit claims for payment under their individual national provider identifier (NPI) number must update their provider file with MassHealth by submitting a request to be  a "no pay" provider. A "no pay " status eliminates the need for a Massachusetts Substitute W-9 and an Electronic Fund Transfer Enrollment/Modification form.

Important Reminder About Ongoing Provider File Maintenance

Providers should not wait until it is time to revalidate to notify MassHealth of changes. MassHealth regulations require that all providers notify MassHealth within 14 days of any change in any of the information submitted in the application. See 130 CMR 450.223(B). 

Changes can be submitted on the POSC. Click on

  • Manage Provider Information, then on
  • Maintain Profile and then on
  • Update Your MassHealth Profile.

Please see the Maintaining MassHealth Provider File Information to learn more. 

Bulletins

MassHealth Provider Bulletins issued to support the revalidation of providers.

  • All Provider Bulletin 242: Provider Revalidation

Additional Resources for

Job Aids and Other Helpful Resources

To comply with the Affordable Care Act (ACA), the Centers for Medicare & Medicaid Services (CMS) requires all enrolled providers to revalidate their enrollment information every five years. MassHealth has created the following job aid to help its providers through this process on the Provider Online Service Center (POSC).

Additional Resources for

Questions

If you have any questions about the information on the revalidation process, please e-mail your inquiry to revalidation@mahealth.net or contact MassHealth Customer Services Center at  (800) 841-2900.

Feedback