HIway Attestation Forms

Mass HIway Attestation Forms

Provider Organizations subject to the HIway Connection Requirement must submit annual documentation attesting to their efforts to implement health information exchange use cases.

Additionally, Acute Care Hospitals will begin to submit information regarding participation in the EOHHS Market-based ENS Initiative. The deadline for submitting documentation regarding 2019 use cases/ENS participation is Dec. 31, 2020.

Provider Organizations must submit via the online Attestation and Exception Webforms. The HIway no longer accepts paper forms.

NEW THIS YEAR: Provider Organizations must enter their organization’s unique ID (and, if applicable, the unique IDs for any sub-organizations) on their attestation/exception form. Your ID is assigned by the HIway and can be found using this document with the unique IDs (version 1/5/2021).

For more information, please review the Mass HIway Regulations Summary and FAQs.                  

Note

We advise that you use the PDF version of the applicable Attestation/Exception Form below to prepare your responses, and then complete the online version. The HIway will not accept digital/scanned PDF submissions.

PDF Preparation Forms

Use the following forms to prepare for filling in your online attestation. Do not submit these forms to the Mass HIway.

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Click here for the Year 2 PDF Attestation Form
(for Small Community Health Centers)

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Click here for the Year 3 and 4 PDF Attestation Form
(for Medium/Large Medical Ambulatory Practices, Large Community Health Centers, and Acute Care Hospitals)

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Click here for the PDF Exception Form
(for provider organizations that did not meet the Connection Requirement in 2019)

Online Attestation and Exception Webforms

Use the online webforms to submit your attestation.

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Click here to access the online Attestation and Exception Forms

Contact The Mass HIway
 

Telephone icon  1-855-MA-HIway
  Options: 
         1 = Enrollment
         2 = Support
         3 = Information
 

Telephone icon  1-866-379-7375
   for password reset requests only,
          between 5 PM to 8:30 AM