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Refer Your Patient

Your patient must meet all three criteria below to qualify:

  1. is 3-64 years of age and;
  2. is a member of MassHealth Standard, MassHealth CommonHealth or MassHealth Care Plus and;
  3. is enrolled in a MCO or ACO organization.

If all three criteria are met, please fill out the referral form below to initiate the member enrollment process.

Patient Referral Form