If you are not a BMC HealthNet Plan network provider and will be administering a one-time service to a member, you must complete this Non-Participating Provider Activation Form to receive your payment.
Fax the completed form along with your W-9 form to 617-897-0818, to the attention of the Provider Enrollment Department.
You must receive prior authorization before delivering services to a BMC HealthNet Plan member. Use the Universal Massachusetts Prior Authorization Form or call 800-900-1451, Option 3.
Please note: If you do not obtain prior authorization, your claim may be denied - unless the claim is for emergency care.
Senior Care Options
If you're delivering a service to a Boston Medical Center HealthNet Plan Senior Care Options member, you must also submit the Waiver of Liability.