Get 90 Day Waiver Rerquest From Mass Health

The 90 Day Waiver Request Form from Mass Health is essential for providers who need to submit claims that exceed the standard 90-day deadline. This guide will walk you through the process of filling out the form online, ensuring that your submission is complete and accurate.

Follow the steps to fill out the 90 Day Waiver Request Form with ease.

1. Click the ‘Get Form’ button to obtain the 90 Day Waiver Request Form and open it for editing.
2. Fill in the 'Date of Request' section with the current date to ensure timely processing.
3. Enter your 'Provider Name' to identify yourself as the submitting provider.
4. Input your 'MassHealth Provider Number/NPI' to link the waiver request to your provider profile.
5. Select the 'Reason for Request' by checking one or more applicable conditions that justify the waiver. Ensure to provide necessary supporting documentation for the selected reason.
6. If 'Other' is selected as a reason, provide a detailed explanation in the designated area.
7. Review all the information you have entered for accuracy and completeness.
8. Once all sections are complete, you can save the changes to your form, download it, or print a copy for your records.
9. Submit the completed form along with the necessary documentation by mailing it to the MassHealth 90-Day Waiver Unit at the specified address.

Take action now and complete your 90 Day Waiver Request Form online to ensure your claims are processed efficiently.