Commonwealth of Massachusetts 
Executive Office of Health and Human Services 
Division of Medical Assistance 
600 Washington Street 
Boston, MA 02111
 
MassHealth 
All Provider Bulletin 109 
April 2000 

TO: All Providers Participating in MassHealth 
FROM: Mark E. Reynolds, Acting Commissioner 
RE: Billing Deadline for MassHealth Claims 

Background

The information in this bulletin supersedes All Provider Bulletin 76, dated 
March 1991. The purpose of this bulletin is to: 

·remind providers of the deadlines for the submission of MassHealth claims; 
·review the process for requesting a waiver of the initial billing deadline; and 
·outline the resubmittal procedures. 

Initial Claim Submission

A claim must be submitted no later than 90 days from the date of service or the 
date on an explanation of benefits (EOB) when other insurance is involved. A 
claim that is initially submitted within the 90-day period may be resubmitted as 
many times as necessary up to 12 months from the date of service. When other 
insurance is involved, the time period is extended to 18 months from the date of 
service. 

A claim submitted beyond the 90-day period will be denied for error code 
296 (billing deadline exceeded).

Appropriate 90-Day Waiver Request

The Division’s billing regulations at 130 CMR 450.000 identify the circumstances 
under which a provider may request a waiver of the initial billing deadline (90-
day waiver). In addition, a provider should request a waiver for a denied claim 
that was submitted by the deadline but now requires a correction of the member’s 
or provider’s MassHealth number. 

Submitting a 90-Day Waiver Request

A request for a 90-day waiver must be submitted to the applicable address below 
and include: 

· a cover letter outlining the reason for the request; 
· documentation supporting the reason for the request; 
· a legible and accurately completed claim form; 
· any forms or attachments required for the processing of the claim; and 
· all remittance advices on which the claim was denied. 



MassHealth 
All Provider Bulletin 109 
April 2000 
Page 2 

Submitting a 90-Day Waiver Request(cont.)

Please send your requests, except for UB-92 inpatient hospital requests, to:

Unisys
Attn: 90-Day Waiver Unit
P.O. Box 9126
Somerville, MA 02145

Please send UB-92 inpatient hospital requests to:

Division of Medical Assistance
Attn: 90-Day Waiver Unit
600 Washington Street
Boston, MA 02111

Decisions on 90-Day

If your waiver request is approved, the claim will appear processed on a Waiver 
Requests remittance advice. If your waiver request is denied, the claim will 
appear processed on a remittance advice with error code 657 (request for 90-day 
waiver denied). 

Resubmittals

To resubmit a claim, please follow the resubmittal procedures outlined in 
Subchapter 5 of your provider manual. 

•Prepare a new, corrected claim form (entering only one claim line per 
claim form). 
•Enter an “X” in the resubmittal box. 
•Enter the transaction control number (TCN) of the original denial as it 
appears on the applicable remittance advice (providers who bill using 
the UB-92 claim form must enter an “R” followed by the transaction 
control number in field 37). 
•Attach any documentation that is required for the correct processing of 
your claim. 
•Resubmit the claim to the following address. 

Unisys 
Attn: Resubmittals 
P.O. Box 9105 
Somerville, MA 02145 

Questions

For more information on 90-day waivers, please refer to the billing instructions 
outlined in Subchapter 5 of your provider manual or contact the Unisys Provider 
Services Department at (617) 628-4141 or 1-800-325-5231.