Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth
	MassHealth
	Long Term Care Facility Bulletin 105
	August 2011




	TO:	Nursing Facilities, Chronic Disease and Rehabilitation Inpatient Hospitals, and 
Psychiatric Inpatient Hospitals Participating in MassHealth

	FROM:	Julian J. Harris, M.D., Medicaid Director

	RE:	Address and Fax Number Changes for Submitting MassHealth Long-Term-Care 
Eligibility Paperwork for New Applicants and Existing Members


Address and Fax	Effective immediately, when submitting all long-term-care intake (new 
Number Changes	member) applications (Senior Medical Benefit Requests (SMBRs)), and
for New Long-Term	intake eligibility paperwork (includes, but is not limited to, all verifications,
-Care Applicants	level-of-care (LOC), and status change (SC-1) forms), please use the 
following MassHealth Enrollment Center (MEC) addresses and fax 
numbers.
	
  For paperwork to be submitted to the Revere MEC:
  MassHealth Enrollment Center
  300 Ocean Avenue, Suite 4000
  Revere, MA 02151
  Fax: 781-485-3402
  
  For paperwork to be submitted to the Springfield MEC:
  MassHealth Enrollment Center
  333 Bridge Street
  Springfield, MA 01103
  Fax: 413-785-4107
  
  For paperwork to be submitted to the Taunton MEC:
  Taunton MassHealth Enrollment Center 
  21 Spring Street, Suite 4
  Taunton, MA 02780
  Fax: 508-828-4634 
		
		(continued on next page)


		
  
Address and Fax 	For paperwork to be submitted to the Tewksbury MEC:
Number Changes 	
for New Long-Term 		MassHealth Enrollment Center 
Care Applicants 		367 East Street 
(cont.) 		Tewksbury, MA 01876
		Fax: 978-863-9231
		
  
Address and Fax 	Effective immediately, all long-term-care eligibility paperwork for existing 
Number Change 	MassHealth members must be processed through the Electronic Document 
for Existing 	Management Center (EDMC). The types of paperwork include, but are not 
Members	limited to, annual reviews, all verifications, and level-of-care (LOC) and status 
change (SC-1) forms. Please use the following address and fax number for 
paperwork intended for the Revere, Springfield, Taunton and Tewksbury MECs.
  
MassHealth Enrollment Center
P.O. Box 1231 
Taunton MA 02780
Fax: 617-887-8777

This information will be included in the next revision of the SMBR and review 
forms.

This bulletin supersedes Long Term Care Facility Bulletin 103 that was issued in 
November 2010.
		

Questions	If you have any questions about the information in this bulletin, please contact 
MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to 
providersupport@mahealth.net, or fax your inquiry to 617-988-8974.
  








			MassHealth
			Long Term Care Facility Bulletin 105
			August 2011
			Page 2