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 186
April 2009

To:
All Providers Participating in MassHealth
From:
Tom Dehner, Medicaid Director  
RE:
Final Deadline Appeal Procedures

Background
Pursuant to M.G.L. c. 118E, s. 38, MassHealth has established 
procedures for appealing claims with service dates exceeding one 
year, or 18 months when third-party insurance is involved, that 
providers believe were denied or underpaid as a result of 
MassHealth error. 
There are two new error codes, 853 and 855, that will be effective 
upon implementation of NewMMIS on May 26, 2009. This bulletin 
lists the conditions that must be met so that appeals can be made.
The Final Deadline Appeals Board has exclusive jurisdiction to 
review the appeals in accordance with MassHealth regulations at 
130 CMR 450.323. 
Appeal Criteria
An appeal must meet all of the following conditions to be 
considered by the Final Deadline Appeals Board.
*	The date of service on the claim that is being appealed must be 
more than 12 months before the appeal, or 18 months when 
third-party insurance is involved, and not more than 36 months 
after the date of service.
*	A denial of the claim must have appeared on a remittance 
advice with error code 853 or 855, indicating that the final 
submission deadline has been exceeded. 
*	The Final Deadline Appeals Board must receive the appeal 
within 30 days of the date of the remittance advice on which the 
claim first appeared as denied with error code 853 or 855.
*	Evidence must be offered to demonstrate that a MassHealth 
error prevented the claim from being processed correctly within 
the applicable filing time limit for claim submission.
*	Remittance advices and other evidence must demonstrate that 
the original submission of the appealed claim was timely and 
that all subsequent available corrective actions outlined in the 
administrative and billing instructions were taken.
(continued on next page)



What to Submit for Your 
Appeal
An appeal that meets the conditions outlined above must include 
the following information:
*	a cover letter outlining the nature of the appeal and the nature 
of the MassHealth error that resulted in the denial or 
underpayment of the claim;
*	a copy of the applicable page from each remittance advice on 
which the claim previously appeared, including a copy of the 
remittance advice that indicates that the final billing deadline 
has passed;
*	a legible and accurately completed paper claim form;
*	evidence of the claim’s original timely submission and 
resubmission, if applicable; and
*	any additional documentation supporting the appeal, including 
any correspondence from MassHealth.
Each claim must be submitted as a separate appeal.
Notification
Written notification of the appeal decision will be sent to the 
provider and constitutes the final agency action.
Where to Send Final 
Deadline Appeals
Appeals must be sent to the following address.
Final Deadline Appeals Board 
MassHealth 
600 Washington Street 
Boston, MA  02111
Questions
If you have any questions about the information in this bulletin, 
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.
To check the status of a pending appeal, please call 617-210-5538, 
or e-mail your inquiry to FDEAppeals@state.ma.us.






MassHealth
All Provider Bulletin 186
April 2009
Page 2