Masshealth Pt1 Form

Masshealth Pt1 Form - What is the PT 1 form Prescription for Transportation PT 1 form request It s submitted by the provider and processed by the Executive Office of Health and Human Services EOHHS Customer Service Team CST Providers can submit the required form online at mass gov how to request transportation for a member

Instructions for Completing the Prescription for Transportation Form Section 1 Enter the member s name date of birth MassHealth member ID telephone number and home address including apartment number if applicable In certain circumstances MassHealth may authorize a member to be picked up at an address other than his her home address

Masshealth Pt1 Form

Masshealth Pt1 Form

Ask your medical provider to fill out a PT-1 form. CONTACT. Talk to your health care provider if you need transportation to and from a non-emergency medical appointment. You can check your eligibility for transportation by calling the MassHealth Customer Service Center at (800) 841-2900.

Online From the homepage menu click Submit PT 1 See section on Logging In Search for member using the MassHealth Member ID or the name and date of birth Click Search Verify the member s information in the next screen If you need to select a different MassHealth member click Clear and Search again

MASSHEALTH PRESCRIPTION FOR TRANSPORTATION FORM

MassHealth medical providers must fill out a PT 1 form online for members eligible for non emergency medical transportation Request transportation for a member MassHealth provider PT 1 web portal MassHealth Transportation Information for Providers

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PT 1 Request Form MA PRESCRIPTION FOR TRANSPORATION FORM Return completed form to MassHealth Transportation Unit P O Box 45 Boston MA 02112 0045 or fax it to 617 988 2925 Please indicate the type of request New Form Renewal Increase in Visits Alternate Pick up Address 1 MassHealth Member Information Member Name

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To qualify for this transportation assistance the member s health care provider or health plan must obtain prior authorization from MassHealth by submitting a Prescription for Transportation otherwise know as a PT 1 Form If approved the rides are arranged between a transportation broker and the MassHealth member

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Submitting a PT 1 Form Request for Transportation By Fax Electronically via the Customer Web Portal CWP Go to Mass gov Masshealth Search Customer Web Portal Click Customer Web Portal Account Request Form

Your MassHealth provider must complete an online transportation request (PT-1) for you. Your provider can find the PT-1 on the MassHealth Customer Web Portal, a website for providers. Any one of your MassHealth providers can submit a PT-1 form for any other MassHealth provider you need to travel to. How long will it take to process my PT-1?

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This transportation is provided through a PT 1 form This form is the authorization to transport a member to a specific location MassHealth members will need a separate form for each location or service that they need to go to Please submit a PT 1 form online through the Customer Web Portal CWP to obtain transportation services for your

Masshealth Pt1 Form

Submitting a PT 1 Form Request for Transportation By Fax Electronically via the Customer Web Portal CWP Go to Mass gov Masshealth Search Customer Web Portal Click Customer Web Portal Account Request Form

Instructions for Completing the Prescription for Transportation Form Section 1 Enter the member s name date of birth MassHealth member ID telephone number and home address including apartment number if applicable In certain circumstances MassHealth may authorize a member to be picked up at an address other than his her home address

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