FEDERALLY REQUIRED DISCLOSURE

MassHealth is required by CMS (Centers for Medicare and Medicaid Services) to have a current Federally Required Disclosure Form on file for every business participating in the MassHealth Medicaid network. MassHealth has posted additional documents to assist businesses in the completion of this form. You can find all documents in the document section located in the menu to the left.

• •   A fillable PDF version of the Federally Required Disclosure Form. The document will then be ready to e-mail to MassHealthEnrollment&Credentialing@dentaquest.com.
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• •   View step by step instructions for the completion of the form.

ADDITIONAL QUESTIONS? 

Please reach out to your provider relations representative-

Dan Archambault - Daniel.archambault@dentaquest.com 

Keishia Lopez Christian - Keishia.lopez@dentaquest.com

Thank you for your participation with the MassHealth Dental Program. 

Please see resources below to help you get started in the new Provider portal