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MassHealth (Massachusetts Medicaid) fax number
(617) 988-8974
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MassHealth Provider Enrollment & Credentialing
Used for: Submitting MassHealth provider enrollment data collection forms and related enrollment documents; e.g., Provider Enrollment Data Collection Form (POSC-DC-PE) and registration materials
Fax destination details
- Department
- MassHealth Provider Enrollment & Credentialing
- Purpose
- Submitting MassHealth provider enrollment data collection forms and related enrollment documents; e.g., Provider Enrollment Data Collection Form (POSC-DC-PE) and registration materials
- Form
- Provider Enrollment Data Collection Form (POSC-DC-PE) — Provider Enrollment Data Collection Form and Registration Instructions
- Address
- MassHealth Provider Enrollment & Credentialing, PO Box 278, Quincy, MA 02171-0278
- 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.
Submit the DC form with your MassHealth provider enrollment package. Forms must be completed (typed signatures preferred), and sent to MassHealth Provider Enrollment & Credentialing at PO Box 278, Quincy, MA 02171-0278 or by fax to 617-988-8974. Use the Existing Provider Modification DC Form for changes to an existing PID/SL. See official MassHealth DC Form FAQ for details.
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