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For changes related to:

  • Business and billing addresses
  • Adding or closing a service site*
  • Tax ID
  • Ceasing business or will no longer provide services in Massachusetts
  • Reporting a new DBA (doing business as name)
  • Providing new services
  • Adding a product to an existing contract

Complete the Update Form for Facilities.

*Note: You must also submit a provider application if:

  • You are moving your only service site (even if simply changing suite numbers), OR
  • You are adding a service site and you are one of the following provider types:
    Ambulatory Surgi-Center
    Assisted Reproductive Technology
    Behavioral Health Facility
    Behavioral Health or State Hospital
    Chronic or Long Term Care Hospital
    Community Mental Health Center
    Early Intervention Program
    Freestanding Clinical Laboratory
    Freestanding Sleep Study Facility/
        Out of Center Testing
    Home Health Care
    Home Infusion Therapy
    Opioid Treatment Program
    Rehabilitation Hospital
    Skilled Nursing Facility
    Technical Diagnostic Imaging
    Transitional Care Unit
    Urgent Care Center