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Submit claims

Are you a MassHealth provider and do you need to submit a claim? You can follow this guide to submit claims online via the Provider Online Service Center (POSC).

MassHealth Customer Service for Providers

The Details   of Submit claims

What you need   for Submit claims

You can only submit non-dental and non-pharmacy claims through the POSC

For all other providers, you must:

  • Have an account with the POSC.
  • Be a contracted MassHealth billing provider prior to submitting any claims.
  • Submit all claims online, unless you have an electronic claim waiver.

From the POSC, you can submit claims individually via direct data entry (DDE) or you can submit batch files.

How to file   Submit claims

For single claims

  1. Login to the POSC.
  2. Submit claims via DDE.

The program will immediately tell you if your claim was paid, denied, suspended, or pended.

For batch claims

First, confirm if testing is needed

Confirm with the MassHealth EDI team to determine if testing is required prior to submitting claim files.

  1. To confirm, email EDI@mahealth.net.
  2. An EDI Analyst will confirm if testing is needed or if the provider is setup to submit claims to production.

Submit batch claims via POSC

  1. Login to POSC.
  2. From the POSC Home Panel:
    1. Click Manage Claims and Payments.
    2. Click Batch Process Claims.
    3. Click Upload Batch Files.
  3. From the Batch Upload Panel:
    1. Select Provider ID from the dropdown list.
    2. Select Transaction Type from the drop down list.
    3. Click Browse to select the file to upload.
    4. Click Upload File.
  4. From the Batch Upload Confirmation Panel:
    1. Review the Batch Upload Confirmation message.
    2. Make a note of your tracking number.
    3. Upload another file, if needed.
  5. Check 999 (HIPAA file acknowledgement).
    1. In 2 to 24 hours after submitting a claims batch, MassHealth will generate a 999 acknowledgement.
    2. The 999 will contain the number of transaction sets received in your file, and their status:
      • A status of "A" in IK501 indicates we accepted the transaction.
      • A status of "R" indicates we rejected the transaction set.
      • In addition to statuses “A” and “R”, it may include a status of “P” for partially accepted in AK901.

Next steps   for Submit claims

  1. For batch claims: if your transactions are denied

    You will need to correct and resubmit your transactions.

    You can only correct and resubmit transactions that are denied.

  2. For batch claims: errors with 999

    If you have errors in your 999, correct and resubmit the electronic batch claim file(s).

Downloads   for Submit claims

Contact   for Submit claims

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