Contracting Applications

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Ancillary Institutional Providers

Complete the Provider Application online. You won't be able to save for later, so please fill out completely.

Provider Application

Important notes

Before you enter the Provider Application, complete and save the required form for your provider type.

Ancillary Institutional Providers:
Ambulance¹ Assisted Reproductive Technology¹ Behavioral Health Hospital² Chronic/Long Term Care Hospital¹ Community Mental Health Center² Durable Medical Equipment¹ Home Health Care¹ Hospice¹ Radiation Oncology Facility¹ Skilled Nursing Facility¹ Transitional Care Unit¹	Ambulatory Surgi-Center¹ Behavioral Health Facility² Cardiac Rehabilitation¹ Clinical Laboratory¹ Dialysis¹ Early Intervention¹ Home Infusion Therapy¹ Independent Physiological and Diagnostic Lab¹ Rehabilitation Hospital¹ Sleep Study Facility¹ Urgent Care Center¹

¹ You must upload the Additional Site of Service form as an attachment when you fill out the Provider Application.

² You must upload the Behavioral Health for Children and Adolescents (BHCA) form as an attachment when you fill out the Provider Application. You must include all their Massachusetts-licensed sites as well as the sites used for home-based BHCA services.

The Provider Application will prompt you to upload supporting documentation for your specialty.
Please note:

We accept only these file types:
.pdf, .doc, .docx, .xls, .xlxs, .csv, .txt, .bmp, .gif, .jpeg, .png, .tiff

Do not use periods in your file name. You can use spaces, dashes, and underscores, but no other special characters. For example:

This file name would be accepted:	Exampledocument1.pdf
This file name would NOT be accepted:	Example.document.1.pdf

Be sure to click the "Yes" button on the final screen to submit your application:

Provider Central

Important notes

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