FEDERALLY REQUIRED DISCLOSURE
**The FRD forms and instructions can be found in the "Documents" section
located in the menu to the left**
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.
• 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.
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ADDITIONAL QUESTIONS?
Please reach out to your MassHealth Credentialing Partner at 1-800-233-1468.
Thank you for your participation with the MassHealth Dental Program.
RESOURCES
Please see resources below to help you get started in the new Provider portal:
MH Provider Portal Browser Tip Sheet
New Provider Portal Manual
New Provider Portal Video
New Provider Portal Self Registration Tips