MassHealth Member File Maintenance

Information about member file maintenance.

Correcting erroneous member information on file

You may verify member eligibility through the Provider Online Service Center. To correct any erroneous information on the eligibility file, call the Member Hotline at [phone].

Timelines for changing a member's information

A member will be added to the system within 24 hours following the receipt of required documentation by the MassHealth Enrollment Center (MEC).

Adding a newborn to the MassHealth system

On behalf of the newborn, the inpatient hospital and parent should send a Notification of Birth form and an application for MassHealth to the regional MEC. Once this information is received and the application is approved, the information should be added to EVS within approximately 10 business days.

Updating a member's third-party insurance information

Third-Party Liability Indicator (TPLI) form

When a provider has evidence that a MassHealth member’s third-party (TPL) health insurance information differs from what appears in the Eligibility Verification System (EVS) record, the provider should inform the Third-Party Liability Unit of the changes. To ensure the member’s file is updated to reflect current information, providers should submit the Third-Party Liability Indicator (TPLI) form with acceptable documentation, verifying the change in coverage, to:

Mailing Address:

MassHealth Third Party Liability Unit
519 Somerville Avenue #372
Somerville, MA 02143

Email: [e-mail]
FAX: [phone]

Acceptable documentation for updating a member’s TPL health insurance information includes an explanation of benefits (EOB) from the insurer, a letter of termination or new coverage notice from an employer or health insurance carrier, or a copy of the health insurance identification card.

NOTE: TPLI form or notice of change to insurance status should not be submitted with claims.

The Third-Party Liability Indicator (TPLI) form is available for download.

To request forms contact MassHealth Customer Service:

Mailing address:

MassHealth Forms Distribution
P.O. Box 278
Quincy, MA 02171

Email: [e-mail] 
FAX: [phone]

Last updated:	April 29, 2024