Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth
	
	MassHealth
	Acute Inpatient Hospital Bulletin 146
	September 2012




	TO:	Acute Inpatient Hospitals Participating in MassHealth

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

	RE:	Notification of Birth (NOB-1) Form Update


Background

The Notification of Birth (NOB-1) form is used by hospitals to facilitate 
eligibility determinations and health plan enrollment for newborns of 
MassHealth- and Commonwealth Care-eligible women.
	

NOB-1 Form is Now Fillable Online

The new NOB-1 form is only available online and must be filled out online.
Go to the MassHealth website at www.mass.gov/masshealth and click the 
link in the lower right corner for provider forms. Please discard all older 
versions of the NOB-1 form.
	
Changes to the NOB-1 Form

The form has been revised in an attempt to improve service and response
time. Specific changes include

a bar code at the top of the form to facilitate scanning;
a field for a hospital contact name and telephone number in order to 
contact the individual who completed the form, if needed;
new instructions directing the person completing the form to fill it out 
online. The new NOB-1 form must be printed out, signed, and faxed to 
the NOB Unit at 617-887-8777. The signed form must also be mailed 
to the MassHealth NOB Unit at 100 Hancock St, Quincy, MA 02171;
clarification that in Section 1, the mother’s MassHealth identification 
number is needed, not her health plan ID number; and 
removal of the shaded background in Section III.
	

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.