Get the free MassHealth Notification of Birth Form (NOB-1)
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Commonwealth of Massachusetts EO HHS www.mass.gov/masshealthNOTIFICATION OF BIRTHHospital Name Hospital AddressInstructions: Complete form and print it out Sign form and fax it to 6178878777Contact
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How to fill out masshealth notification of birth
How to fill out masshealth notification of birth
01
Step 1: Fill out the top section of the form with the parent or guardian's information, including their name, address, and phone number.
02
Step 2: Provide the baby’s name, date of birth, and gender in the appropriate sections.
03
Step 3: Fill out the section related to the parent or guardian's insurance information, if applicable.
04
Step 4: Include any additional information or notes that may be required, such as the date of enrollment or any special instructions.
05
Step 5: Sign and date the form to certify its accuracy.
06
Step 6: Submit the completed form to the MassHealth office or the designated authority.
Who needs masshealth notification of birth?
01
Anyone who has given birth to a child and wants to apply for MassHealth benefits for their newborn needs to fill out the MassHealth Notification of Birth.
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What is masshealth notification of birth?
The masshealth notification of birth is a form that must be submitted to MassHealth when a baby is born to a member who is enrolled in a MassHealth plan.
Who is required to file masshealth notification of birth?
The parent or legal guardian of the newborn baby is required to file the MassHealth notification of birth form.
How to fill out masshealth notification of birth?
The form can be filled out online on the MassHealth website or by contacting MassHealth directly for assistance.
What is the purpose of masshealth notification of birth?
The purpose of the MassHealth notification of birth is to ensure that the newborn baby is added to the member's MassHealth plan for coverage.
What information must be reported on masshealth notification of birth?
The form typically requires information such as the baby's name, date of birth, parent's name, and MassHealth member ID.
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