The Massachusetts Aca 1202 form is a Physician Certification and Attestation Form required for physicians seeking eligibility for Section 1202 rates under the Affordable Care Act. This form ensures that Medicaid agencies provide appropriate payments for specific primary care services delivered by qualified physicians. To qualify, physicians must meet certain criteria and submit the completed form to MassHealth Customer Service.
The Massachusetts ACA 1202 form is a critical document for physicians seeking reimbursement for specific primary care services under the Affordable Care Act. This form serves as a Physician Certification and Attestation, enabling eligible doctors to access Section 1202 rates for Medicaid services provided during the calendar years 2013 and 2014. To qualify, physicians must attest that they specialize in family medicine, general internal medicine, or pediatric medicine, and they must provide evidence of board certification or demonstrate that a significant portion of their Medicaid claims—specifically, 60%—pertains to eligible services. The form requires detailed physician information, including practice areas, business contact details, and MassHealth provider IDs. Physicians must submit the completed form to MassHealth Customer Service, ensuring that all sections are accurately filled out and signed. In addition, it is important to note that all information provided is subject to audit, underscoring the need for accuracy and honesty in the submission process. For further assistance, physicians can access their eligibility status online, making it easier to navigate the complexities of the Medicaid reimbursement landscape.
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Filling out the Massachusetts ACA 1202 form is an important step for physicians seeking eligibility for specific Medicaid reimbursement rates. Here are key takeaways to consider:
Missing Required Information: Failing to fill in all necessary fields can lead to delays or rejection of the form. Ensure that every section, especially your contact details and provider IDs, is complete.
Incorrect Certification: Not accurately attesting to your specialty or board certification can disqualify you. Double-check that you select the correct practice area and provide valid certification dates.
Omitting Managed Care Entity Information: If you are enrolled with a MassHealth-contracted managed care entity, it’s crucial to include this information. Leaving it out can lead to complications in processing your application.
Ignoring Submission Guidelines: Not following the submission instructions can cause your form to be rejected. Remember to fax or mail it to the correct address and include any required attachments.
Failing to Review for Accuracy: Submitting the form without a thorough review can result in mistakes that may affect your eligibility. Take the time to verify all information before sending it off.
Not Keeping Copies: Failing to keep a copy of your submitted form can lead to issues if there are questions or if you need to reference it later. Always retain a copy for your records.
Missing Signature: Forgetting to sign the form is a common error that can halt the entire process. Ensure that you provide your signature and the date before submission.
When filling out the Massachusetts ACA 1202 form, consider the following guidelines to ensure a smooth process:
What is the Massachusetts ACA 1202 form?
The Massachusetts ACA 1202 form is a certification and attestation form for physicians who provide primary care services. It allows eligible physicians to receive enhanced payment rates for certain Medicaid services as mandated by Section 1202 of the Affordable Care Act.
Who needs to fill out the ACA 1202 form?
Physicians who practice in family medicine, general internal medicine, or pediatric medicine, and who want to qualify for the enhanced payment rates under Section 1202 should complete this form.
What information do I need to provide on the form?
You will need to provide your name, business name, contact information, and details about your practice. Additionally, you must attest to your board certification status or provide evidence that at least 60% of your Medicaid claims are for eligible services.
How do I submit the ACA 1202 form?
You can submit the completed form by fax to 617-988-8974 or by mailing it to the MassHealth Customer Service at the specified address. Ensure that all sections are filled out completely before submission.
What happens if I do not complete the form correctly?
Only completed forms will be accepted. If your form is incomplete or incorrect, it may be rejected, which means you won’t be eligible for the enhanced payment rates.
How can I check my eligibility for Section 1202 rates?
You can view your eligibility status by accessing your physician profile online at the MassHealth Provider Online Service Center. This will provide you with the most up-to-date information regarding your status.
What are the eligible billing codes for Section 1202 rates?
The eligible billing codes include Evaluation and Management (E&M) codes ranging from 99201 to 99499, as well as specific vaccine administration codes. For a complete list, refer to the relevant administrative bulletins or the Physician Manual.
Is there a deadline for submitting the ACA 1202 form?
While the form should be submitted as soon as possible to ensure eligibility, there may be specific deadlines set by MassHealth. It is advisable to check with MassHealth Customer Service for any time-sensitive requirements.
What should I do if I have questions about the form?
If you have questions regarding the ACA 1202 form or its requirements, you can contact MassHealth Customer Service for assistance. They can provide guidance and clarify any uncertainties you may have.
What are the consequences of providing false information on the form?
Providing false information can lead to serious consequences, including civil penalties or criminal prosecution. It is crucial to ensure that all information you provide is accurate and truthful.
After gathering the necessary information, you will be ready to fill out the Massachusetts ACA 1202 form. This form is essential for physicians seeking eligibility for specific primary care service rates. Follow the steps below to ensure that you complete the form accurately and submit it correctly.