The State Organization Index provides an alphabetical listing of government organizations, including commissions, departments, and bureaus.
Top-requested sites to log in to services provided by the state
To adjust a paid claim, enter the most recently paid ICN. Incorrectly paid claims can be adjusted when you are not changing the member ID, claim form type, or provider number. For more information, please read Corrective Action for Incorrectly Paid Claim.
If your claim was denied as a result of a data-entry error, you do not need to rebill it if the image of the claim in the system is clear and correct. A MassHealth Customer Service representative will reprocess the claim. Please call 1-800-841-2900 to request that the claim be reprocessed. MassHealth will reprocess keying errors over the telephone, unless the image of the original claim is so poor that it cannot be reimaged/reprocessed. In that case, the provider will be asked to rebill the claim.
A suspended claim is a claim that has been received, but that requires review before final adjudication. When a claim appears as suspended on your remittance advice (RA), the ICN assigned to the claim will remain the same throughout the processing cycle. You should post the claim as received by MassHealth. Do not rebill the claim. The suspended claim will appear on a subsequent RA as paid or denied.
Effective June 1, 2012, MassHealth providers can submit a final deadline appeal request to MassHealth using the Request for Claim Review form.
This form and its accompanying reference guide is the result of a collaborative effort between the Massachusetts Health Care Administrative Simplification Collaborative (HCAS), MassHealth, and several statewide health plans. The 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.
The Request for Claim Review form and the Reference guide are available at the HCAS Web site www.hcasma.org. To facilitate the transition to the new form, please read MassHealth answers to frequently asked questions.
MassHealth denies any claim received more than 12 months after the date of service (up to 18 months for those involving a third party insurer) for exceeding the final billing deadline. It may, however, be submitted for consideration as a final deadline appeal when the criteria below are met.
A claim submitted after 36 months from the oldest date of service cannot be appealed and will appear on the remittance advice as denied.
The provider must meet all of the following criteria.
You must submit the following documentation with each claim for which you are requesting a final deadline appeal:
Requests for final deadline appeals should be sent to the appropriate address listed in Appendix A of your MassHealth provider manual.
After review, you will receive a letter either approving or denying the appeal request. Any further communication about that appeal should be addressed to the person who signed the letter. For more information, please read Billing Timelines and Appeal Procedures.