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Posc Dc (Commonwealth of Massachusetts)

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BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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Data Collection Form and Registration Instructions
Commonwealth of Massachusetts | EOHHS | www.mass.gov/masshealth
MMIS allows providers to conduct day-to-day business with MassHealth electronically, via the Provider Online Service Center
(POSC) and the Automated Voice Response (AVR) system. All users need a user ID and password to access these systems.
Please identify a primary user (account administrator) for your organization. The primary user will be the person in your
organization who will be responsible for the creation and inactivation of users’ accounts and password resets.
Please complete this form to obtain a user ID and password for the primary user to access the POSC and AVR. Once the
primary user is registered, he/she will need to create subordinate IDs for all other users within your organization and
authorize access for business partners, such as billing agencies.
Provider’s name Provider’s ID or application tracking number (ATN)
Primary user’s last name First name Middle initial
Month and date of birth (MMDD) User-defined unique four-digit PIN
(required field)
Work zip code
Work email address Existing Virtual Gateway user ID
(if applicable)
Contact phone number
Check one:
MassHealth provider Provider applicant Change Primary User
Provider type: MCO Nursing facility PACE SCO Billing agency EHR Incentive Program All others
I certify that the information on this form and any attached statement that I have provided has been reviewed and signed by
me, and is true, accurate, and complete, to the best of my knowledge. I understand that I may be subject to civil penalties or
criminal prosecution for any falsification, omission, or concealment of any material fact contained herein.
Provider’s signature (signature and date stamps, or the signature of anyone other than the provider, are not acceptable) Date
The above data can be sent by email to the MassHealth Customer Service Center at PINregistrationsupport@mahealth.net.
You can also mail or fax this form to the following address and fax number.
MassHealth
P.O. Box 121205
Boston, MA 02112-1205
Fax: (617) 988-8904
Upon receipt of this completed form, MassHealth will manually create a user ID and a password. The Virtual Gateway will
then send the user ID and password to the primary user at the email address provided on this form.
POSC-DC (Rev. 05/18) (over)
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After receiving the user ID and password, the primary user must take the following steps.
• Change the password. Once the primary user has registered, he/she must go to the Virtual Gateway at
https://gateway.hhs.state.ma.us/authn/index.jsp to change the password. A series of “I forgot my password”
questions under the “Manage My Profile—Authentication Questions” tab must be answered before the password
can be changed.
• Assign and link subordinate IDs. Once registered, the primary user must create a user account for each individual
user in the organization needing access to the POSC, and give permission to share data with other entities who
conduct business on their behalf. The primary user can also link an individual user who already has a user ID to a
new provider by selecting the “Administer Account” link.
• Assign an alternate primary user. It is suggested that the primary user assign a backup primary user with all of the
privileges of the primary user to perform the above steps in the primary user’s absence. MassHealth recommends
that primary users assign users only the access they need and not grant every user full access.
• Primary user changes. Providers must notify MassHealth of any changes to the primary user.
• Changing a Primary User. By checking the Change Primary User box, the prior primary user will be removed and the
person noted above will be assigned as the new primary user.
Your user ID and password will give you access to the POSC. You will also need these credentials to access the AVR system
to verify member eligibility.
When using the POSC, you will need your provider ID and service location number (PID/SL) to view reports, remittance
advices, letters, direct data entry (DDE), and Health Insurance Portability and Accountability Act (HIPAA) transactions.
MassHealth will mail the PID/SL to you separately.
Please remember that you must submit your national provider identifier (NPI) on the HIPAA batch transactions. If you are
an atypical provider (that is, not required to have an NPI), please include your PID/SL on your batch transactions.
If you have any questions about this registration process, please contact the MassHealth Customer Service Center at
(800) 841-2900, or by email at PINregistrationsupport@mahealth.net.
Mail or fax this form to the MassHealth Customer Service Center, P.O. Box 121205, Boston, MA 02112-1205; Fax: (617) 988-8904.
If you have questions about this form, call the MassHealth Customer Service Center at (800) 841-2900.
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Posc Dc (Commonwealth of Massachusetts)

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Completed 26 July 2020

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