MassHealth claims information for direct data entry (DDE)

Information that will help you with DDE submissions

How to submit a claim

To submit claims with or without attachments, see the appropriate job aid in "Additional Resources," below.

Additional Resources

MassHealth MMIS Job Aid: Institutional Claims Submission

MassHealth MMIS Job Aid: Institutional Claims Submission

MMIS Job Aid: Professional Claim Submission with MassHealth

MMIS Job Aid: Professional Claim Submission with MassHealth

Residential Care Home Guide to the Remittance Advice for Paper Claims and Equivalents

Residential Care Home Guide to the Remittance Advice for Paper Claims and Equivalents

Correcting a denied claim

To resubmit a denied claim, refer to the MMIS Job Aid: Resubmit a Denied Claim in "Additional Resources," below.

Additional Resources

MassHealth MMIS Job Aid: Resubmit a Denied Claim

MassHealth MMIS Job Aid: Resubmit a Denied Claim

Adjusting/replacing a paid claim with the correct internal control number (ICN)

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 refer to the MMIS Job Aid: Replace a Claim in "Additional Resources," below. 

Additional Resources

MassHealth MMIS Job Aid: Replace or Adjust a Paid Claim

MassHealth MMIS Job Aid: Replace or Adjust a Paid Claim

Suspended claims

A suspended claim is a claim that has been received, 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 while it is in suspense. The suspended claim will appear on a subsequent RA as paid or denied.