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  • Ma Combined Mco Outpatient Review Form

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94.7634: to Network Health: 1.888.977.0776 member information (Verify eligibility before rendering services) Member Name Member ID# D.O.B. provider information treatment status Agency Name (Please rate the patient s response to treatment since last review or since start of treatment if this is first report) Provider ID Much Worse Clinician Name Phone # Fax# Are Psychotropic meds being prescribed? Yes No Unknown RN,CS/NP PCP MD If yes, prescribed by: Slight Imprvmnt Major Imprvmnt.

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How to request Login to your Customer Service Web Account. On the right hand menu, click PT-1 Request Management. Click Create New PT-1. Follow the instructions and fill out the form.

If you need medical transportation before that, your medical provider can call the MassHealth Customer Service Center at (800) 841-2900 to request verbal approval. Who will provide my transportation after my PT-1 is approved?

Phone MassHealth Customer Service Call HST & PT-1 Transportation, MassHealth Customer Service at (800) 841-2900. MART Call HST & PT-1 Transportation, MART at (866) 834-9991. GATRA Call HST & PT-1 Transportation, GATRA at (800) 431-1713. HST Office Call HST & PT-1 Transportation, HST Office at (617) 847-3427.

If you have questions or comments about the MassHealth Guidelines for Medical Necessity Determination, call MassHealth Customer Service 1-800-841-2900, send an email to provider@masshealthquestions.com, or send a fax to 617-988-8974.

MassHealth provides non-emergency ambulance service if your medical condition requires an ambulance. The staff will be able to enter the home to provide further assistance. Any service comments or complaints should be directed to your assigned broker.

Contact Department: DME-Nutritional Authorizations Team—Department; Clinical Operations. Tel.: (855) 444-4647 (toll free), Fax: (617) 586-1700.

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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