Get Newmmis Allows Providers To Conduct Day-to-day Business With Masshealth Electronically, Via The

This guide provides clear, step-by-step instructions for filling out the NewMMIS form, essential for providers conducting business with MassHealth electronically. By following these instructions, users can efficiently complete the form and access necessary online services.

Follow the steps to complete the NewMMIS form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Identify the provider name and enter it in the designated field.
3. If applicable, provide the provider number or the application tracking number in the specified area.
4. Enter the primary user's last name, first name, and middle initial in the corresponding fields.
5. Provide the month and date of birth in MMDD format for the primary user.
6. Create a unique four-digit PIN number that the primary user can define.
7. Fill in the work zip code of the primary user in the appropriate field.
8. Input the work email address for the primary user.
9. If the primary user already has an existing Virtual Gateway user ID, include it in the provided field.
10. Enter the contact phone number for the primary user.
11. Select one option to indicate whether you are an existing provider or a provider applicant.
12. Choose the appropriate provider type from the available options such as MCO, nursing facility, PACE, SCO, billing agency, or others.
13. Review the certification statement regarding the accuracy of the information provided and ensure it is signed by the primary user.
14. Submit the completed form via email, fax, or postal mail to MassHealth Customer Service, ensuring that you retain a copy for your records.
15. Once you receive your primary user ID and password via email, remember to change the password and assign subordinate IDs as needed.

Complete and submit your NewMMIS form online to access MassHealth services efficiently.