MassHealth Cover Sheet Desk Guide | Page 1 VG Automated Cover Sheet (generated automatically with a new VG application) ----- Document type VG signature pages for under-age-65 applications (VG signature pages, Eligibility Representative Designation (ERD) form (if applicable), Permission to Share Information (PSI) form, Absent Parent Assignment of Rights pages) When to send After submission of VG application Where to send MassHealth Central Processing Unit (CPU) P.O. Box 290794 Charlestown, MA 02129 ----- Document type VG verifications for applicants under age 65 When to send At time of application submission (VG) Where to send CPU Fax: 617-887-8799 ----- Document type VG signature pages for Community Elder applications (VG Signature pages, Eligibility Representative Designation (ERD) form (if applicable), Permission to Share Information (PSI) form, Absent Parent Assignment of Rights pages, and Personal Care Attendant (PCA) pages) When to send After submission of VG application Where to send MEC Fax: 617-887-8777 MassHealth Enrollment Center (MEC) P.O. Box 1231 Taunton, MA 02780 ----- Document type Verifications for VG Community Elder applications (aged 65 or older—not long-term-care (LTC) intake) When to send At time of application submission (VG) Where to send MEC Fax: 617-887-8777 ----- The following addresses and fax numbers are to be used only for long-term-care (LTC) intake applications. Please use your facility fax/mail cover sheet. Note: New address and fax; formerly the Revere MEC. 45-47 Spruce Street Chelsea, MA 02150 Fax: 617-889-3285 333 Bridge Street Springfield, MA 01103 Fax: 413-785-4107 21 Spring Street, Suite 4 Taunton, MA 02780 Fax: 508-828-4634 367 East Street Tewksbury, MA 01876 Fax: 978-863-9231 ----- Please Remember: 1) Do not photocopy fax cover sheets. For bar codes to work properly, cover sheets must be originals, not photocopies. 2) Use a separate fax cover sheet for each household. Do not send items for multiple households under the same fax cover sheet. 3) Put a check mark next to the item(s) that you are sending. PAGE BREAK MassHealth Cover Sheet Desk Guide | Page 2 MassHealth Cover Sheet (get it by clicking here) http://www.mass.gov/eohhs/docs/masshealth/provider-services/forms/mfcs.pdf ----- Document type Paper under-age-65 applications; Paper Community Elder applications (aged 65 or older—not long-term-care (LTC) intake) When to send After applicant has filled out the application Where to send MassHealth Central Processing Unit (CPU) P.O. Box 290794 Charlestown, MA 02129 ----- Document type Community Elder verifications (aged 65 or older—not long-term-care (LTC) intake) for paper applications only When to send At time of application submission (Paper) Where to send CPU Fax: 617-887-8799 ----- Document type VG and paper-application verifications in response to a Request for Information (VC-1) form sent by MassHealth for under-age-65 or Community Elder cases When to send After receiving the Request for Information (VC-1) Where to send Fax number on the VC-1, or check MAP ----- Document type MAP One-Time Permission to Share Information (PSI) form only Where to send MassHealth Enrollment Center P.O. Box 1231 Taunton, MA 02780 Attention: One-Time PSIs Please Note: MAP currently lists a different address for mailing these documents. We are in the process of updating this. ----- Document type Any other documents not mentioned elsewhere in this desk guide (annual reviews, changes, etc.) for any type of case, including non-intake LTC cases Where to send MassHealth Enrollment Center P.O. Box 1231 Taunton, MA 02780 VERIFICATIONS: MEC Fax: 617-887-8777 ------ The following addresses and fax numbers are to be used only for long-term-care (LTC) intake applications. Please use your facility fax/mail cover sheet. Note: New address and fax; formerly the Revere MEC. 45-47 Spruce Street Chelsea, MA 02150 Fax: 617-889-3285 333 Bridge Street Springfield, MA 01103 Fax: 413-785-4107 21 Spring Street, Suite 4 Taunton, MA 02780 Fax: 508-828-4634 367 East Street Tewksbury, MA 01876 Fax: 978-863-9231 ----- Please Remember: 1) Do not photocopy fax cover sheets. For bar codes to work properly, cover sheets must be originals, not photocopies. 2) Use a separate fax cover sheet for each household. Do not send items for multiple households under the same fax cover sheet. MHCS Guide (09/12)