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  • Protected Health Information Release Form - Masshealth-dental

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Serving the MassHealth Program* PROTECTED HEALTH INFORMATION RELEASE FORM (AUTHORIZATION) A photocopy of this authorization shall be considered as effective and valid as the original TO: MassHealth.

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Contact support

Contact Phone. Main: Call MassHealth Customer Service Center for Providers, Main: at (800) 841-2900. Open Monday–Friday 8 a.m.–5 p.m. ... Online. Email Email MassHealth Customer Service Center for Providers at provider@masshealthquestions.com. Fax. (617) 988-8974.

If you get SSP payments AND other benefits from DTA, you must contact the DTA Assistance Line at (877) 382-2363 for a benefit verification letter. If you are authorized for access to someone's SSP case, you can contact the SSP Assistance Line for a benefit verification letter.

If you have questions about accessing your personal record, please contact the MassHealth Privacy Office at privacy.officer@mass.gov or (617) 573-1656. For all other issues, please see the Contact MassHealth page or contact MassHealth Customer Service by calling (800) 841-2900.

Requirements. Whether or not you have to file a Massachusetts personal income tax return, anyone 18 years old or over must get and maintain creditable health insurance coverage as long as it's considered affordable under the schedule set by the Massachusetts Health Connector.

Acceptable income documents include: Your most recently federal income tax return 1040, 1040A, or 1040EZ. Social Security benefit award letter or annual benefit statement (SSA-1099)

MassHealth and Medicare provide free or low-cost health insurance coverage to eligible individuals and families. The guide below provides information on the public insurance programs that are available in Massachusetts, how to determine if you are eligible, and how to apply for coverage.

What you need Social Security numbers, if you have them, for every household member who is applying. Federal tax returns, if you file. Information about citizenship or national status or immigration status. Employer and income information for everyone in your household (for example, from paystubs or wage statements)

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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