Help

MassHealth Provider Online Service Center

Provider Enrollment Application

Add Provider Registration

The Request Provider Enrollment Application - Registration panel allows the user/provider to view and maintain provider enrollment registration name and address information. The panel allows the user to register with the RER portal.

• Fields marked with a red asterisk (*) are required.

• Dates must be in mm/dd/ccyy format. Clicking on the calendar box creates a popup calendar to aid in date selection and entry.

• Error Resolution:

If an error is detected a statement is displayed in the upper portion of the panel. The statement indicates the problem and the method of correction and is preceded by a small red circle with a white "x" () in it. The small red circle with a white "x" () also appears next to required fields that are in error.

• Click to close this Help panel.

1

Directions for entering any of the values on the Registration panel follow:

Type Values

Type values in the Last Name, First Name, and MI fields.

Type or Select Values

Type a value in the Date Of Birth field or select it from the calendar date box.

Type Values

Type values in the PIN, Contact Address Line 1, Contact Address Line 2, and City fields.

Drop Down List Box

Select a value from the drop down list box for the State field.

Type Values

Type values in the Zip Code, Phone Number, and Email fields.

2

To back out any changes on any panels that have not been saved yet, click on Cancel Service on the Registration panel.

OR

Any unsaved modifications or deletes to any panels during this process are backed and the system returns to the initial Start An Enrollment Application - Security Warning panel.

3

Click I'm not a robot checkbox to display the reCAPTCHA challenge pop-up to verify user is not a robot.

This displays the Google reCAPTCHA challenge pop-up. If challenge is not met successfully, the reCAPTCHA challenge pop-up will refresh with a different challenge until the user gets it right. Hitting ESC key will close the pop-up and go back to the original panel with Submit button still disabled since the challenge was not met.

4

Click on Submit on the Registration panel.

The system continues the provider enrollment process and displays the Registration Confirmation panel. This button will be disabled by default until the reCAPTCHA challenge has been met successfully.

5

Click on Back on the Registration panel.

The system navigates to the previous panel in the provider enrollment process and displays the Enrollment Type panel.