Final Deadline Appeal
Frequently Asked Questions (FAQs)

Overview of the Request for Claim Review Form

MassHealth has worked with several statewide health plans to develop a 
consolidated claim review form for final deadline appeal requests authorized 
pursuant to MassHealth regulations at 130 CMR 450.323(A). Effective June 1, 
2012, MassHealth will adopt the use of the Request for Claim Review 
Form.

The resulting Request for Claim Review Form was adopted in July 2011 by private 
health plans in Massachusetts to ease administrative burdens for providers in 
managing different appeal forms with different payers. 

An accompanying Request for Review Form Reference Guide acts as a provider 
resource for submission criteria and respective documentation requirements for 
each health plan.

What is the effective date?

Effective June 1, 2012. 

Does MassHealth require providers to use the form when submitting a final 
deadline appeal request?

Effective June 1, 2012, MassHealth providers submitting a request for a final 
deadline appeal are strongly encouraged to use the Request for Claim Review 
Form.

Should I use the form if I am submitting an electronic final deadline appeal via 
direct data entry (DDE)?

The Request for Claim Review Form should be used to submit electronic final 
deadline appeal requests to MassHealth. Please note that final deadline appeals 
submitted on paper should also include the Request for Claim Review Form.

Do I still need to provide accompanying documentation?

Yes. You must submit the documentation with each claim for which you are 
requesting a final deadline appeal, pursuant to MassHealth regulations at 130 
CMR 450.323(B). This includes, but is not limited to

a statement outlining the nature of the appeal, including a description of the 
MassHealth error that resulted in the denial or underpayment of the claim;
a copy of the applicable page of each remittance advice on which the claim has 
appeared, including the one on which the claim was denied for "Final Deadline 
Exceeded;"
any other documentation supporting your appeal; and
a legible and accurately completed paper claim form, if applicable.

Is MassHealth changing the criteria for the final deadline appeal process?

No. MassHealth is NOT changing the final deadline appeal process. However, the 
process was recently automated to accommodate electronic submitters. Providers 
must continue to meet the criteria outlined in MassHealth regulations and in 
final deadline appeal procedures. For more information, please see 130 CMR 
450.323: Appeals of Erroneously Denied or Underpaid Claims and All Provider 
Bulletin 221, dated December 2011.



Where can I get a copy of the Request for Claim Review Form?

A copy of the form and reference guide is located at the HealthCare 
Administrative Solutions, Inc. (HCAS) Web site at www.hcasma.org/index.html

Whom should I contact if I have questions or need assistance filling out the 
form? 

If you have any questions about the information in this document, please contact 
MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to 
providersupport@mahealth.net, or fax your inquiry to 617-988-8974.