Pre-Payment Validation Process

In the Medicaid EHR Incentive Program validation process, Provider Enrollment and Verification Analysts (PEVAs) validate whether incentive applications comply with the program requirements. This includes verification that all supporting documentation demonstrates eligibility and MU compliance.

Applications can go through several validation ⇒ correction ⇒ resubmission cycles before approval. At the end of a validation cycle, applications are either approved for payment, or set back to incomplete in MAPIR. When an application is set to incomplete, the provider receives an email listing the discrepancies and required corrections. 


Supporting Documentation

The supporting documentation uploaded with the MAPIR application serves as proof the provider satisfied the program requirements. Applications that cycle during validation are typically submitted with missing or incomplete documentation. Access the MU Toolkits for the program guidelines, or click on these documentation guides:

      2017 Supporting Documentation Guide for EPs
      2016 Supporting Documentation Guide for EPs
      2015 Supporting Documentation Guide for EPs

      2017 Supporting Documentation Guide for EHs
      2016 Supporting Documentation Guide for EHs
      2015 Supporting Documentation Guide for EHs

Two Phase Process

The validation process is divided into the eligibility and MU phases. Feedback is provided separately for each stage. Technical Assistance is available for both phases to clarify the identified compliance discrepancies to the providers.

1)  Eligibility Phase
 

The Eligibility phase is executed first. Eligibility covers the following items:

Eligible Professionals

 

Eligible Hospitals

  • Proof of Certified EHR Techology (CEHRT)

 

  • Proof of Certified EHR Techology (CEHRT)

  • Patient Volume Threshold (PVT)

 

  • Patient Volume Threshold (PVT)

  • Non-Hospital based provider status

 

 

  • FQHC provider status (If FQHC was selected)

 

 

2) MU Phase
 

The application moves to the MU Phase, once eligibility is satisfied. MU covers the following items:

Eligible Professionals

 

Eligible Hospitals

  • Compliance with MU Objectives and Measures

 

  • Compliance with MU Objectives and Measures
  • MU Aggregation Form
   
     

Approval and Incentive Payment

Once an application is validated and approved, the incentive is typically paid in 4 to 6 weeks. MAPIR does not create an application for the next program year until the payment is made. Ensure your application is compliant at least 10 weeks before the deadline of the next program year, or you may miss the opportunity to attest for that program year.

Aborting an Application

MAPIR will not create a new application for the next program year when a prior incentive application is still pending for approval and payment. If you believe that approval and payment for a prior application cannot be achieved, you can abort the MAPIR application. MAPIR will then create a new incentive application.
 

Technical Assistance (TA)

Technical Assistance is available to help providers through the validation and correction process. First line guidance is provided by the PEVAs. Extensive education and guidance is provided by Technical Assistance specialists (TAs).

TAs can explain registration, attestation and documentation requirements, but cannot prepare applications, review new iterations of application data, validate documents prior to MAPIR submission, or waive program rules. 

Click here to read more about the available Technical Assistance.

Working with the PEVAs and TAs

To expedite approval of an open application, we advise you to:

  • Make best effort to submit the correct supporting documentation with initial submission
  • Expediently provide additional documentation requested during the validation process
  • Stay engaged with your PEVA and TA
  • Respond at your earliest convenience, when a PEVA or TA reaches out to provide guidance
  • Correct and resubmit the application within 5 business days after receiving feedback and guidance

Without exception, program compliance of applications remain the sole responsibility of the providers. The requirements are defined by CMS and MassHealth and cannot be overruled by PEVAs or TAs.

Only the attesting provider, their designee, or the alternate contact can obtain status updates from PEVAs or TAs. To secure the privacy of applicants, no information can be provided to the payee, business owner, or other entity not designated by the provider.

To reach a PEVA or TA, contact MeHI via:    1-855-MassEHR           MassEHR@masstech.org
 

Post-Payment Audits

After receiving the incentive payment, providers may be selected for a post-payment audit. In an audit, a CMS or MassHealth auditor will further investigate in more detail whether a provider truly met the compliance standards.

While passing the pre-payment validation reasonably verifies compliance, it is not a guarantee a provider will pass the post-payment audit. Only full compliance to the program regulations provides this assurance.