Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth	

	MassHealth
	All Provider Bulletin 134
	April 2004

	TO:	All Providers Participating in MassHealth

	FROM:	Beth Waldman, Medicaid Director

	RE:	Billing Deadline for MassHealth Claims

Background	The information in this bulletin replaces that found in All Provider Bulletin 109, dated April 2000. The purpose of this bulletin is to: 

•	notify hospitals of the new address for the submission of inpatient 90-day waiver requests;
•	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	All MassHealth claims must be submitted within 90 days of the date of 
Submission 	service or the date on an explanation of benefits (EOB) from a primary
	payer.  A claim that is initially submitted within the 90-day billing deadline and denied for a correctable error 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 billing deadline will be denied for error code 296 (billing deadline exceeded).

Appropriate 90-Day	MassHealth’s billing regulations at 130 CMR 450.000 identify the 
Waiver Request 	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 90-day billing deadline but requires a correction to the member’s identification number or the pay-to provider number.
	
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Submitting a 90-Day	All requests for 90‑day waivers, including for acute and chronic disease
Waiver Request	and rehabilitation inpatient hospitals, must be submitted to the 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						
ATTN: 90‑Day Waiver Unit
P.O. Box 9101				
Somerville, MA  02145		

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).

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