Massachusetts Sample Letter for Notification of Hearing
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How to fill out Sample Letter For Notification Of Hearing?
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FAQ
Fill out the Fair Hearing Request Form. Fax the form to the Office of Medicaid, Board of Hearings at 1-617-887-8797.
License Suspension Appeals can be resolved through the Registry of Motor Vehicles Driver Control Unit and/or the Division of Insurance Board of Appeals. Depending on the basis of your suspension you may be limited to just the Board of Appeal.
Submit 90-day waiver requests via direct data entry (DDE) on the Provider Online Service Center (POSC). With each claim, include a copy of all remittance advices (RAs) where the claim has appeared, if applicable. Submit all supporting documentation with each claim, such as copies of retroactive enrollment notices.
You must file the appeal within 30 days of the date that appears on the remittance advice on which your claim first denied with error code 853 or 855.
Faxing or efaxing these materials to (617) 887-8797; or by ? Calling (800) 841-2900, TDD/TTY: 711, to fill out your request for a fair hearing form by phone.
Customers must visit the Online Service Center, select Reservations and select Make or Cancel a Hearing Reservation. No walk-ins will be allowed. At this time chemical test refusal hearings cannot be scheduled via the internet and requires an in-person visit to the Haymarket (Boston) Service Center.
Contact Phone. Main: Call MassHealth Customer Service for Providers, Main: at (800) 841-2900. Open Monday?Friday 8 a.m.?5 p.m. TTY: Call MassHealth Customer Service for Providers, TTY: at 711. Online. Email Email MassHealth Customer Service for Providers at provider@masshealthquestions.com. Fax. (617) 988-8974.
Fill out the Fair Hearing Request Form. Fax the form to the Office of Medicaid, Board of Hearings at 1-617-887-8797.
