NewMMIS Job Aid: Replace a Claim

You would replace a paid claim if it paid incorrectly and must be adjusted. The 
ICN for the new adjusted claim will begin with “59.” This job aid describes how 
to:

* Replace a claim after it has been paid by MassHealth.  

Access Inquire Claim Status
From the MassHealth Provider Online Service Center home panel:
1. Click Manage Claims and Payments. 
2. Click Inquire Claim Status. The Search for Claims panel is displayed.
Enter Search Criteria
From the Search for Claims panel:
3. Select Provider ID from the drop-down list.
4. Enter the Member ID.
5. Enter From Date of Service and To Date of Service, within a six month time 
span. 
Note: If you know the exact date of the service, the From and To dates will be 
the same date.
Note:  For more effective claim searching, enter as much search information as 
possible. 
Or,  enter an ICN, which returns only the specific claim in the Search Results.
6. Click Search.
From the Claims Search Results panel:
7. Select the paid claim to be adjusted/replaced. 
Review the Claim Detail Panel
From the Claim Detail panel:
8. Review the claim details.
9. Click Replace.
Continue with the Billing Information Panel
From the Billing Information panel:
10. Enter the claim information for the replaced claim as you would for any new 
claim.
11. Navigate to the extended Services Tab
12.Go to the Claims Notes Detail panel
13. In the Claim Note Type field select ADD from the drop down list
14. Enter the applicable Note Reason code & definition in the Claim Note 
Description field
      Note: Please refer to the applicable Companion Guide for the list of Note 
Code Reasons and definitions
15. Click Add 






MassHealth Provider Online Service Center	1 of 1	Revised: December 6, 2012