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Masshealth request for services form

Masshealth request for services form 2025

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The document is a bulletin from the Commonwealth of Massachusetts' Executive Office of Health and Human Services, specifically addressing PACE providers participating in MassHealth. It announces a revision to the Request for Services form, which must be used starting October 1, 2002, to facilitate communication between providers and the Division. The form is required for determining clinical eligibility and must be completed by a registered nurse. Instructions for obtaining the form and contact information for inquiries are also provided.

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2002	4.8 Satisfied (195 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I know what kind of MassHealth I have?

If you want to see information about your health assistance benefits online, use My Account Page. My Account Page can help you manage your MassHealth, Commonwealth Care, Health Safety Net, Childrens Medical Security Plan and Healthy Start benefits.

How do I get a pt1 form for MassHealth?

How to request Login to your Customer Service Web Account. On the right hand menu, click PT-1 Request Management. Click Create New PT-1. Follow the instructions and fill out the form.

What types of MassHealth plans are there?

Managed care eligible members can choose from the following health plan options: Accountable Care Partnership Plan. Primary Care ACO. Managed Care Organization (MCO) Primary Care Clinician (PCC) Plan.

What is a pidsl for MassHealth?

Each providers NPI is associated in MassHealths Medicaid Management Information System (MMIS) with a corresponding MassHealth provider ID and service location (PID/SL). This PID/SL is 10 characters, made up of a 9-digit base number and an alpha service location (e.g. 123456789A).

What is a provider data collection form for MassHealth?

In general, a MassHealth Data Collection (DC) Form is used by provider organizations to assign a Primary User to a newly enrolled Provider ID/Service Location (PID/SL) or to modify the Primary User assigned to an existing PID/SL. Each DC form includes key information and instructions on how to complete the form.