Get Masshealth Remittance Advice Via Posc Form

The Masshealth Remittance Advice Via Posc Form is an essential document for obtaining remittance advices from MassHealth. This guide provides clear steps to assist users in completing the form accurately online, ensuring a smooth request process.

Follow the steps to fill out the Masshealth Remittance Advice Via Posc Form

1. Press the ‘Get Form’ button to access the Masshealth Remittance Advice Via Posc Form and open it in your preferred editor.
2. Enter the provider's legal name in the 'Provider (Legal Name)' section.
3. Fill in the 'Tel. no.' field with the primary contact number for the provider.
4. In the 'Provider Remittance Address' section, provide the street address where remittance advice should be sent.
5. Complete the 'City' field with the name of the city corresponding to the remittance address.
6. Input the 'NPI or Provider ID/Service Location' for the specific provider or practice.
7. List the run numbers per service location in the designated fields under 'List Run Numbers per Service Location'.
8. In the 'Calculate Fee' section, multiply the number of total run numbers by the fee of $10. Fill in the total fee calculated.
9. Check the 'Requested Media Type' section to indicate whether you want a paper copy or a PDF file on CD.
10. Provide the name of the individual completing the form, and ensure to sign in the 'Signature' section.
11. Fill in the 'Phone no.' and 'E-mail address' fields for any necessary follow-up communication.
12. Enter the date of completion in the 'Date' field.
13. Once you have reviewed the entire form, save your changes, then print or share the document as needed.

Take action now and complete your Masshealth Remittance Advice Via Posc Form online.