Executive Office of Health and Human Services - Online Attestation Form

Mass HIway Connection Requirement


Welcome to the Mass HIway Attestation Form

Please read this before requesting an on-line Attestation Form

This Mass HIway Attestation Form shall be completed by Provider Organizations in order to report compliance with the requirement that Provider Organizations connect to the Mass HIway in accordance with the Mass HIway Regulations (101 CMR 20.00).

The Mass HIway is the Commonwealth's statewide, state-sponsored health information exchange. For more information, visit the Mass HIway Regulations Summary and Mass HIway Regulations FAQ.

An authorized representative at the Provider Organization should complete and submit this attestation form by July 1 of the attestation year.

Important Messages

In order to access an on-line version of the Attestation Form, please submit your name and email below. An access code with instructions will be sent to the email address that you provide. You only need to request an access code once. The access code that you will receive can be used to access the Attestation Form at any time until you submit the completed Attestation Form.

IMPORTANT: Online Mass HIway Attestation Forms must be completed and submitted in one session. Data cannot be entered and saved in the online Attestation Form for completion at a later time. If you are not ready to complete the full Attestation Form at this time, we suggest that you use the PDF version of either the Year 1 Attestation Form or Year 2 Attestation Form to plan and prepare responses, then complete the online version when all of your responses are ready.

Access the Attestation Form

* Required Field *
* Please Enter the valid Email *