Mail fax 2026

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The document is a Mail/Fax Cover Sheet for submitting health coverage applications and verifications to MassHealth and the Health Connector. It provides instructions on how to properly send documents, including the importance of using original cover sheets with barcodes, and specifies where to send different types of applications and verifications. Additionally, it includes contact information for assistance and emphasizes confidentiality regarding the transmitted information.

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Click ‘Get Form’ to open the mail fax cover sheet in the editor.
Begin by entering the last four digits of the Head of Household’s Social Security Number or their initials along with their date of birth in the designated fields.
Fill in the sender's information, including name, Social Security Number, phone number, and date of birth. If applicable, include the name of the facility and MassHealth ID number.
Indicate the number of pages being sent, ensuring you count both cover sheets.
Review all entered information for accuracy before finalizing your document.

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