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MassHealth Registration Requirement: What ALL LICSWs in MA Must Do

Thursday, December 7, 2017   (1 Comments)
Posted by: Jamie Klufts
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What ALL Massachusetts Licensed Independent Clinical Social Workers (LICSWs) Must Do to Comply with the MassHealth Registration Requirement

All Licensed Independent Clinical Social Workers (LICSWs) in Massachusetts are required to register with MassHealth as either billing or non-billing providers. This requirement was put in place to ensure that MassHealth is in compliance with the Affordable Care Act. The MA Board of Registration of Social Work REQUIRES ALL LICSWs to meet this requirement by September 30, 2018! Failure to do so could result in the suspension or loss of your license.

  1. A non-billing provider is a LICSW who does not bill MassHealth directly for any client services. If you see MassHealth clients and bill Beacon, MBHP, Tufts Public, or HNE, you are NOT billing MassHealth directly; you MUST register as a non-billing provider (unless you are a QMB provider, see below). Most LICSWs fall within the non-billing provider camp.
    1.  To register as a non-billing provider, download and fill-out the non-billing provider contract and application here. As stated on the contract, mail completed and signed documents to MassHealth Customer Service Center, Attn: Provider Enrollment, P.O. Box 121205, Boston, MA 02112-1205.


  2.  A billing provider is a LICSW who is registered with MassHealth and is authorized to bill MassHealth directly for client services. If you are a QMB provider and bill MassHealth for co-pays for your Medicare clients who have MassHealth secondary, you are already registered and you do not need to do anything. If you believe that you are a billing provider, but not a QMB provider, please contact MassHealth Customer Service Center at 1-800-841-2900 in order to get additional information or request an application.

If you still have questions about how to complete this requirement, or if questions come up as you go through the process of completing the form, please consult these instructions and questions and answers, below. 


Step-by-Step Instructions and Q&As

A Guide to the New Requirement and to Filling Out the Non-Billing Provider Application and Contract


Filling out the Non-Billing Provider Application

Legal Name

  • How are you legally known, as a person, to the government? Example: the name on your license and/or how the IRS knows you.  If your middle name is in one of those places and your middle initial or there’s no middle name in another place, it’s not a problem.

  •  Make sure you put theidentical name where it asks for your name elsewhere on the application and on the contract.

  • If you have a DBA, don’t include it.


  • Use your social security number instead of your EIN.

  • Only use an EIN if you own a group practice. Write in a box (missing on application form) and check it. You are required to send in a photocopy of the letter from the IRS giving you your EIN along with the application.

    • If you have an EIN but cannot locate the letter from the IRS, you can do any of the following:

      • Contact the IRS and ask for a duplicate copy of the letter.

      • Submit instead a copy of a pre-printed “tax coupon/payment voucher” from the IRS that contains your name, address and tax ID.

Primary Taxonomy Code:

  • LICSWs should leave this part blank; it's only for medication prescribers.

DEA Number

  • LICSWs should leave this blank; it’s only for medication prescribers.

 License from another state

  • If no, leave blank.

 Home Street Address and contact information:

  • Has to be where you actua

    lly reside—no PO Boxes permitted.

    • Note: MassHealth will not display this information anywhere; it’s just for their records.

Primary Service Location (PSL)

  • If different from your Home Address, put here information about the location where you spend the majority of your time doing clinical social work-related work. 

  • If not different from your home address, leave blank.

  • Note: The address you have listed with the NPI registry (which it’s a good idea to update as needed) is irrelevant to this application.

 PSL name and PSL MassHealth provider ID:

  • If you work most of the time at a clinic or hospital or agency that has a name, put it here.

  • If that facility has a MassHealth provider ID, put it here.

  • If it doesn’t have a MassHealth provider ID, leave it blank.

  • Note: If you work in multiple Service Locations list them in the available sections. Use a separate piece a paper if more Service Locations need to be listed.

Section 2A: Owners, Managing Employees, and Agents of Applicant:

  • This section refers only to your business of providing health care.  Read the material below--If your business has co-owners, or paid managers, or agents, if your business is paying a mortgage on property that belongs to it, or if you have a family member involved as owner, managing employee, or agent of the business, indicate yes and provide the information. Otherwise, check “none.”

  • Note: If you employ a billing person or company, they count as an agent.

Section 3: Certification Statement:

  • Make sure that your Printed Legal Name is the same as the name you put at the beginning of the application.

Non-Billing Provider Contract

  • Legal Name  must be the same as on the application.
  •  For Title, put your academic degree.

Questions and Answers

  •  What is the turnaround time for approval of applications?  “A few weeks” but if your application has inconsistencies on it, it may take longer for you to get a response.
  •  Are we going to have to be enrolled as either non-billing or billing MassHealth providers in order to renew our licenses in September 2016?We have heard from the Board of Registration of Social Workers that enrollment will not need to be completed in time for the September 2016 license renewal. They recommend all LICSWs complete this process as soon as possible, but you will not have to attest to fulfilling this requirement until your next license renewal (2018).
  • What if I already submitted an application but haven’t heard back about it?Wait a month for MassHealth to contact you. If you still don’t receive a response, LICSWs may contact Provider Enrollment at  MassHealth/Maximus via email:
  •  What if I don’t do any clinical work even though I am a LICSW? You will still need to be enrolled in MassHealth either as a billing or non-billing provider as a condition for licensure or relicensure (renewal).
  • What if I am a provider for MBHP, Beacon, or another Managed Care Organization and work with people on MassHealth? Do I still need to be enrolled separately as a MassHealth provider?Yes, you do. Being a provider for a managed care company that has a contract with MassHealth does not satisfy the requirement.
  • If I am treating people on MassHealth as a Beacon or MBHP provider, am I required to also be abillingMassHealth provider? No, you do not. The two are totally separate. You can be a non-billing MassHealth provider if you prefer.
  • Do I have to be a Medicare provider in order to be a MassHealth provider? You are not required to be a Medicare provider to bea non-billing MassHealth provider; however, you are required to be a Medicare provider to bea billing MassHealth provider.
  • The Affordable Care Act requires that any time a provider bills MassHealth for certain types of services, the provider has to put the NPI number of a referring clinician who is a MassHealth provider on the claim in order for the provider to get paid. I have billing-related questions that pertain to meeting this requirement:  No date has been set yet for that requirement to go into effect. A detailed bulletin describing the new billing procedures will be coming out in 4-6 weeks. Meanwhile, the rollout starts simply with “informational messaging” on the EOB’s. For a list of the services and categories of professionals that this requirement applies to, go here.
  •  I work in a hospital and we bill MassHealth under their MassHealth number.  I do not have my own individual MassHealth provider number.  Do I need to register?Yes, you do.  If you cannot individually bill MassHealth under your own name, you must still register with them.
  • Does my multidisciplinary group practice (which is not a MassHealth provider) need to do the paperwork for the application and contract?For groups who do not accept MassHealth, the individual providers under that group must register with MassHealth to be compliant.
  • What does ORP and O&R refer to?ORP stands for “ordering, referring and prescribing,” which is the category of activities that non-billing providers are able to do.  O&R stands for “ordering and referring.” These terms are synonymous with “non-billing provider.”
  • Whom do I contact if I still have a question about the application process? What if I already submitted an application but I know I didn’t do it according to these instructions? Contact MassHealth/Maximus via email: or telephone: 800-841-2900

If you have other questions, please contact:

Jonas Goldenberg, LICSW

Director of Clinical Issues & Continuing Education

NASW - MA Chapter

617-227-9635 x114

NASW - MA Chapter would like to thank the Massachusetts Psychological Association (MPA) for their permission to excerpt this article, and to Michael A Goldberg, PhD. and James Leffert, Ed.D, who wrote the original article and Q&As for MPA (March 2016).  Thanks also go to Karla Burgos, Sr. Provider Relations Specialist at Maximus for editing this document for accuracy.


Elizabeth Zoob says...
Posted Monday, May 7, 2018
It would be helpful if there were a clear link to the documents this article refers to. (If it is here on this page, I could not find it.) I finally found the document via Google:

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