Pt1 form online 2025

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The document is a bulletin from the Massachusetts Executive Office of Health and Human Services regarding the revised Prescription for Transportation (PT-1) form used by MassHealth providers. It outlines changes to the form, including updates to member ID, provider information, and additional sections for alternate addresses and authorized signatures. The bulletin encourages electronic submission of requests and provides instructions for requesting supplies of the new form, along with contact information for inquiries.

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Click ‘Get Form’ to open the pt1 form in the editor.
In Section 1, enter the MassHealth member's last name, first name, date of birth, member ID, and telephone number. Provide the home address and any alternate pick-up address if applicable.
Proceed to Section 2 and fill in the provider's name, telephone number, address, MassHealth provider ID/service location, and NPI. Ensure that the provider is an active MassHealth participant.
In Section 3, indicate if the treating provider is the same as listed in Section 2 by checking the appropriate box. If different, provide their details.
Describe the medical treatment type in Section 4 and specify how long and how frequently transportation will be needed in Section 5.
In Section 6, explain any medical reasons preventing public transportation use. Indicate additional needs like a wheelchair van or escort in Section 7.
Finally, sign Section 8 to certify that all information is accurate before submitting your completed form.

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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 get my MassHealth tax form?

Important: If you would like to request a duplicate Form 1095-B, you may visit our self-service site at .masshealthtaxform.com or contact the MassHealth Customer Service Center at (866) 682-6745; TDD/TTY: 711. You will need your MassHealth member ID, last name, and date of birth to request your Form 1095-B.

How do I get a PT1 form for MassHealth?

Ask your medical provider to fill out a PT-1 form You can check your eligibility for transportation by calling the MassHealth Customer Service Center at (800) 841-2900. Your MassHealth provider must complete an online transportation request (PT-1 form) for you. There is no paper form.

Does MassHealth CommonHealth cover PT-1?

Any MassHealth member within a category that includes transportation-eligible coverage (Standard, CommonHealth, CarePlus, or others) can qualify. If eligible, how would I apply for service? Your MassHealth medical provider must complete and sign a Prescription for Transportation (PT-1) form on your behalf.

What is the monthly income limit for MassHealth?

(effective March 1, 2025), The general income limits for seniors (age 65+) and adults with disabilities seeking MassHealth Standard coverage while living in the community are approximately: Single Person: $1,255 per month. Married Couple: $1,704 per month (for the couple together)

How to use PT-1?

Online + From the homepage menu, click Submit PT-1 (See section on Logging In) Search for member using the MassHealth Member ID or the name and date of birth. Verify the members information in the next screen. Select the PT-1 submitter from the list of providers linked to your account.

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How much is the provider application fee for MassHealth?

The following provider types must pay the provider application fee (unless paid to Medicare or another state Medicaid program) when enrolling, re-enrolling, or adding a new service location. For the calendar year 2025, the application fee is $730. All other provider types are exempt.