Provider Forms and References | UnitedHealthcare Community Plan of Massachusetts

See the forms below to stay up-to-date on changes and other issues that are important to your practice.

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Disclosure of Ownership

National Disclosure Provider Roster Addendum Formopen_in_new
MassHealth Disclosure Form for Entities - Online Versionopen_in_new
MassHealth Federally Required Disclosure Individual Practitioners - Online Versionopen_in_new
UnitedHealthcare Community Plan of Massachusetts Provider Disclosure of Ownership Forms FAQopen_in_new

Submit a Pre-Service Appeal and or Grievance for a Medicaid Member

Medicaid Pre-Service Appeal or Grievance