Complete the following form to submit the provider contract.
The MassHealth Nonbilling Managed Care Entity (MCE) Network-only Provider Contract. Download it to your computer.
The PDF has fillable fields | Word Open it on your computer, type in your information, and print out the form.
ALL fields are required, and you will need to sign your signature with pen. Please write legibly.
When you have filled in ALL the fields and have signed the contract, SCAN the file and submit it below.
NOTE: You must hit the SUBMIT FORM button after uploading the contract. The SUBMIT FORM button sends the contract to the right address. If you send it to another email address, your contract will not reach us.