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  • Federally Required Disclosure Form Mass Health

Get Federally Required Disclosure Form Mass Health

Federally Required Disclosures Ownership and Control, Business Transactions and Criminal Convictions (42 CFR 455.100 106, 42 CFR 455.436, and 42 CFR 1002.3) Federal law requires fiscal agents, managed.

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Federal law requires fiscal agents, managed care entities (MCEs), and other MassHealth providers, including applicants and certain bidders seeking to provide MassHealth services, to disclose some or all of the following: business ownership and control, business transactions, and criminal convictions.

Taxpayers and tax return preparers use this form to disclose items or positions that are not otherwise adequately disclosed on a tax return to avoid certain penalties.

How to enroll Online + The fastest way to enroll in a health plan is online. By phone + Call the MassHealth Customer Service Center. We can help. (800) 841-2900. ... By mail + Fill out a MassHealth Health Plan Enrollment Form. English. ... By fax + You can fax your MassHealth Health Plan Enrollment Form to (617) 988-8903.

Providers can download a copy of most MassHealth forms or request a supply of forms through the MassHealth website at .mass.gov/masshealth. Or providers can use this request form and fax it to 617-988-8973. Providers can also request forms by e-mailing publications@mahealth.net or by calling 1-800-841-2900.

My Account Page lets you review your health assistance benefit information, including the status of documents and notices. Your personal information will be on the Health Assistance tab in My Account Page (MAP). Be sure to carefully review all information on the page.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232