Change of Address - Provider Requirements

Providers must notify MassHealth of any changes in their information.

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.
• Submit a Provider Change of Address Form.

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.

Additional Resources

Change of Address Provider Requirements by Provider Type

Change of Address Provider Requirements by Provider Type

Massachusetts Substitute W-9 and Provider Change of Address Forms

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 [phone].

For MassHealth Dental Providers

Log in to the MassHealth Dental Program portal.  

or

Call DentaQuest at [phone].