Correcting erroneous member information on file
You may verify member eligibility through the Provider Online Service Center, or through the EVSpc software, if it is installed on your system. You may also call the,Automated Voice Response (AVR) system, to verify eligibility information. To correct any erroneous information on the eligibility file, call the Member Hotline at 1-800-841-2900.
Timelines for changing a member's information
A member will be added to the system within 24 hours following the receipt of required documentation by the MassHealth Enrollment Center (MEC).
Adding a newborn to the MassHealth system
On behalf of the newborn, the inpatient hospital and parent should send a Notification of Birth form and an application for MassHealth to the regional MEC. Once this information is received and the application is approved, the information should be added to EVS within approximately 10 business days.
When a provider has evidence that a MassHealth member’s third-party (TPL) health insurance information differs from what appears in the Eligibility Verification System (EVS) record, the provider should inform the Third-Party Liability Unit of the changes. To ensure the member’s file is updated to reflect current information, providers should submit the Third-Party Liability Indicator (TPLI) form with acceptable documentation, verifying the change in coverage, to:
MassHealth, Third Party Liability Unit
PO Box 9212
Chelsea, MA, 02150
Acceptable documentation for updating a member’s TPL health insurance information includes an explanation of benefits (EOB) from the insurer, a letter of termination or new coverage notice from an employer or health insurance carrier, or a copy of the health insurance identification card.
NOTE: TPLI form or notice of change to insurance status should not be submitted with claims.
The Third-Party Liability Indicator (TPLI) form is available for download.
To request forms contact MassHealth Customer Service:
MassHealth Forms Distribution
P.O. Box 9118
Hingham, MA 02043
This information is provided by MassHealth.