Get Masshealth Notification Of Birth Form (nob-1)

Filling out the MassHealth Notification Of Birth form (NOB-1) online can simplify the process of enrolling your newborn for health coverage. This guide provides clear, step-by-step instructions to ensure that you can complete the form accurately and efficiently.

Follow the steps to complete the MassHealth Notification Of Birth form online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. In Section I, provide the mother's information. Enter the mother’s MassHealth Member ID, full name, address, date of birth, and telephone number. Also, include the primary insurer or guardian’s name, along with their relationship to the newborn, and any primary commercial insurance details if applicable.
3. Proceed to Section II where you will enter the child's information. Fill in the child's last name, first name, and middle initial. Enter the child’s date of birth in MM/DD/YYYY format and select the gender by entering 'M' for male or 'F' for female. Avoid using 'BABY GIRL' or 'BABY BOY' as it may delay processing.
4. Indicate whether an application for the child’s social security number has been made through the hospital by selecting 'Yes' or 'No'.
5. In the certification area, sign and date the form, including your title. Ensure that the signature is from the appropriate authority, such as the director of medical records or patient accounts manager of the hospital.
6. Fax the signed original form to 617-887-8777 to submit it to MassHealth. Checking member eligibility in the Eligibility Verification System is also advisable.
7. Finally, save your changes, download, print, or share the form as needed.

Complete your MassHealth Notification Of Birth form online today to ensure your newborn's health coverage!