Blue Cross Blue Shield of Massachusetts fax number

Fax destination details

Department

Member Service

Purpose

Used to designate an authorized representative for a member and to request disclosures; also used for one-time disclosures and to document legal representation

Form

Medex Member’s Designation of an Authorized Representative; Permission for One-Time Disclosure of Information; Documentation of Legal Representative Status for Member — Medex Member’s Designation of an Authorized Representative; Permission for One-Time Disclosure of Information; Documentation of Legal Representative Status for Member

Address

101 Huntington Avenue, Suite 1300, Boston, MA 02199-7611

Voice phone

617-246-5000

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Instructions include directing questions to the Member Service department; mail or fax the completed form to the address or fax number listed (Fax: 1-617-246-3674). Each form explains how to designate an authorized representative or request a one-time disclosure, and how to document legal representation.

Official form instructions are published as a downloadable file on the organization's website.