Each MassHealth provider must notify the MassHealth agency prior to or no later than the date of the change. Failure to do so constitutes a breach of the provider contract which may be subject to fines or termination. See the regulations at 130 CMR 450.223(B):
Providers can report their change in one of two ways
- Update request on the Provider Online Service Center (POSC). Changes made via the POSC may still require the submission of a paper document. This option is not available for Ordering, Referring, and Prescribing (ORP) providers.
- Both ORP and Fee-for-Service providers can submit a Provider Change of Address Form.
- MassHealth Nonbilling Managed Care Entity (MCE) Network-only Provider must refer to their plan to update their address.
Change of Address Provider Requirements by Provider Type
To understand what documents are needed for certain types of address changes, please refer to the Change of Address Provider Requirements document below.
Massachusetts Substitute W-9 and Provider Change of Address Forms
The MA Substitute W-9 is required if you are changing your legal entity or check mailing address. Please refer to the Change of Address Grid above to confirm if it is required for your provider type.
Massachusetts Substitute W-9 Form (English, PDF 346.7 KB)
Massachusetts Substitute W-9 Form (English, DOCX 37.84 KB)
MassHealth Provider Change of Address Form (English, PDF 74.89 KB)
MassHealth Provider Change of Address Form (English, DOCX 25 KB)
For MassHealth LTSS Providers
Log in to the MassHealth LTSS Provider Portal.
or
Call the MassHealth LTSS Provider Service Center at (844) 368-5184.
For MassHealth Dental Providers
| Last updated: | August 20, 2024 |
|---|