MassHealth (Massachusetts Medicaid) fax number

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

Voice phone

MassHealth Customer Service for Providers: 1-800-841-2900; Fax: 617-988-8974

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.