Federally Required Disclosures

The Executive Office of Health and Human Services (EOHHS)/MassHealth requires Fallon Community Health Plan (FCHP), as a MassHealth contracted Managed Care Organization (MCO), to obtain certain information from its contracted providers. Providers are required to check the HHS-OIG List of Excluded Entities and Individuals and Entities (LEIE) and the General Service Administration (GSA) Excluded Parties List System (EPLS) on a monthly basis to ensure that they are not employing or contracting with excluded entity programs discussed in the Provider Manual section titled: Key Compliance and Regulatory Requirements for Providers. Providers must also disclose the following information as required by federal law, 42 CFR §§ 455.100-106:

  • Individuals with business ownership and control interests
  • Business transactions/managing employee information
  • Criminal convictions of the provider and other parties associated with the provider’s entity

To meet these MassHealth disclosure requirements, FCHP must obtain a completed Federally Required Disclosure Form from providers and other disclosing entities, whenever one of the following conditions exists:

  • upon submission of a provider application;
  • upon execution of the provider agreement;
  • upon revalidation of enrollment (and within 35 days after any change in ownership of the entity required to disclose.

Secure electronic form

For your convenience, all data will be collected electronically utilizing the MassHealth-required Federally Required Disclosure form, which may be accessed through our secure electronic form.  IPA/PHO groups, please contact your Contract Manager or Provider Services Representative to expedite this requirement.

Please note that providers are required to update this information when changes occur.  In the future, this information will be requested at the time of recontracting/recredentialing for existing providers and credentialing/contracting for new providers.

Frequently asked questions

This frequently asked questions document will provide further information regarding this request. If, however, you have any questions, please don’t hesitate to contact us by calling 1-866-ASK-FCHP (1-866-275-3247), or e-mailing us at askfchp@fchp.org with the following as your email subject: "Provider Disclosure Request."

As always, we appreciate your assistance and support.

Quick links: MassHealth Federally Required Disclosures