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How to use or fill out the RY2018 MassHealth Acute Hospital Pay-for-Performance Program Form

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the required hospital information in the designated fields, including HOSPITAL NAME, MASSHEALTH PROVIDER ID, and HOSPITAL STREET ADDRESS. Ensure all entries are accurate.
  3. Continue filling out the CEO NAME and PHONE number. This information is crucial for verification purposes.
  4. Review the data accuracy and completeness requirements outlined in the form. Make sure you understand what needs to be submitted for compliance.
  5. In the Measures Exemption section, mark an 'X' in the blank spaces next to any quality measures that do not apply to your hospital for each quarter.
  6. Finally, ensure that you sign and date the form at the bottom. This certifies that all provided information is true and complete.

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