Provider Eligibility

To participate in MassHealth as a MassHealth independent nurse provider, a nurse must (A) be licensed and in good standing as a nurse by the board of registration in nursing, or equivalent agency, for the state(s) in which the nursing services are provided; (B) meet all provider eligibility requirements in 130 CMR 450.212: Provider Eligibility: Eligibility Criteria, including 130 CMR 450.212(A)(6); (C) sign a MassHealth provider contract and receive a MassHealth provider number. The MassHealth agency does not pay an independent nurse for nursing services provided before the date on which the nurse is approved by the MassHealth agency to participate in MassHealth; (D) agree to comply with all the provisions of 130 CMR 414.000, 130 CMR 450.000: Administrative and Billing Regulations, and all other applicable MassHealth rules and regulations, including but not limited to administrative tasks such as maintenance of the member’s record; (E) participate in any independent nurse provider orientation and training required by EOHHS; (F) agree, and respond in a timely manner, to periodic audits by the MassHealth agency or its designee that assess the quality of member care and ensure compliance with 130 CMR 414.000; and (G) notify the MassHealth agency in writing within 14 days of any change in any of the information submitted in the provider application in accordance with 130 CMR 450.223(B): Provider Contract: Execution of Contract.