Providers may update their information on the Provider Online Service Center (POSC) instead of using the MassHealth Provider Change of Address Form. For information on how to update your provider file, please refer to the job aid located at www.mass.gov/masshealth. Click on New Medicaid Management Information System (NewMMIS) and the Provider Online Service Center (POSC), then Need Additional Information or Training?, then Get Trained, then Update Provider Profile under the heading Provider Profile Maintenance. Changes made via the POSC may still require the submission of a paper document.
Legal Entity Address Change
All providers must submit the following:
- updated
Massachusetts Substitute W-9 Form
with original signature - Provider Change of Address Form (PDF)
Note: P.O. box numbers are not acceptable as legal entity addresses.
Check Mailing Address Change
All providers must submit the following:
- updated Massachusetts Substitute W-9 Form with original signature
- Provider Change of Address Form (PDF)
Note: P.O. box numbers are acceptable as check mailing addresses.
Billing Mailing/Information Mailing Address Changes
All providers must submit a Provider Change of Address Form.
Note: P.O. box numbers are acceptable for these addresses.
Doing Business As (DBA) Address Change
Certain provider types must meet additional MassHealth requirements when changing business location,
as indicated below.
Note: If you hold a license/certification from the Department of Public Health (DPH), you must notify DPH
before moving to your new location. P.O. boxs are not acceptable.
The provider types listed below must submit a Provider Change of Address Form, or notify MassHealth via the POSC.
01 Physician
02 Optometrist
03 Optician
04 Ocularist
05 Psychologist
06 Podiatrist
07 Therapist
08 Nurse Midwife
10 Dentist (all updates are handled by DentaQuest)
15 Optometry School
16 Chiropractor
17 Nurse Practitioner
21 Family Planning Agency
22 Abortion/Sterilization Clinic
23 Speech and Hearing Clinic
24 Rehabilitation Clinic
25 Renal Dialysis Clinic
27 Chapter 766
29 Early Intervention Program
33 Targeted Case Management
44 Hearing Instrument Specialist
49 Transportation
50 Audiologist
58 Fiscal Intermediary Service
59 Personal Care Agency
61 Independent Nurse
66 Independent Living Center
81 Hospital Licensed Health Center
86 QMB-Only Providers
87 Radiation and Oncology Treatment Center
89 School-Based Medicaid
91 Indian Health Services
97 Group Practice Organization
The provider types listed below must submit the following:
- letter of intent
- Provider Change of Address Form (PDF)
- IRS welcome letter/document to confirm tax ID (legal entity and doing business addresses only)
- Medicare letter or complete copy of 855S application (doing business address only)
- copy of new lease, mortgage, or deed (doing business address only)
- copy of accreditation
41 Durable Medical Equipment and Medical Supplies
42 Oxygen and Respiratory Therapy Equipment
43 Prosthetics
47 Orthotics
The provider types listed in the following table must submit the following:
- Provider Change of Address Form (PDF)
- approval from the MassHealth program manager for your provider type (legal entity and doing business addresses only)
62 Adult Foster Care and Group Adult Foster Care
63 Adult Day Health
64 Day Habilitation Program
The provider types listed in the following table must submit the following:
- written request on letterhead with original signature (letter of intent)
- new MassHealth application
20 Community Health Center
53 State School ICF/MR
69 Hospice Care
70 Acute Inpatient Hospital (in or out-of-state)
71 Chronic Inpatient Hospital
74 Semi-Acute Hospital
75 Semi-Acute Outpatient Hospital
80 Acute Outpatient Hospital (in or out-of-state)
82 Chronic Outpatient Hospital
84 Freestanding Ambulatory Surgical Center
97 Group Practice Organization - only if requesting to bill from additional location
The provider types listed below must submit the following:
- Provider Change of Address Form (PDF)
- updated copy of DPH license showing the new address (for DBA address only)
26 Mental Health Clinic
28 Substance Abuse Program
45 Independent Diagnostic Testing Facility
65 Psychiatric Day Treatment
The provider types listed below must submit the following:
- Provider Change of Address Form (PDF)
- updated copy of DPH license showing the new address (for DBA address only)
- notify the MassHealth program manager to update RFA
73 Psychiatric Inpatient Hospital
83 Psychiatric Outpatient Hospital
The provider types listed below must submit the following:
- Provider Change of Address Form (PDF)
- updated copy of CLIA license showing the new address (for DBA address only)
46 Independent Clinical Laboratory
The provider types listed below must submit the following:
- Provider Change of Address Form (PDF)
- letter of intent
40 Pharmacy
The provider types listed below must submit the following:
- Provider Change of Address Form (PDF)
- copy of explanatory letter sent to DPH
- copy of lease, mortgage, or deed
55 Residential Care Home
The provider types listed below must submit the following:
- Provider Change of Address Form (PDF)
- copy of explanatory letter sent to DPH
- copy of approval of move from DPH
- copy of lease, mortgage, or deed
09 Nursing Facility
The provider types listed below must submit the following:
- Provider Change of Address Form (PDF)
- copy of Medicare welcome letter with new address, OR
- 855 application
60 Home Health Agency
This information is provided by MassHealth.