HIway Attestation Forms

The Mass 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 webform. 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.

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

Recommendation

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, which will go live on this page soon. HIway will not accept digital/scanned PDF submissions.

Forms

  • Click here for the Year 2 Attestation Form (for Small Community Health Centers) 
           
  • Click here for the Year 3 and 4 Attestation Form (for Medium/Large Medical Ambulatory Practices, Large Community Health Centers, and Acute Care Hospitals)
     
  • Click here for the Exception Form (for provider organizations that did not meet the Connection Requirement in 2019).