MassHealth providers, Billing Intermediaries, and Software Vendors are reminded that submitters may use replacement transactions to adjust paid claims only. If the submitter is trying to correct a paid claim where the member ID, provider ID, and claim type are staying the same, they can send in a replacement claim with appropriate lines from the original claim (both paid and denied). Submitters should not use claim frequency code equal to “7” for resubmitting denied claims. These claims will deny for MassHealth EOB 0500 ADJUSTMENT FAILED and/or 1100 ADJUST: FORMER ICN INCORRECT.
For questions, please refer to the MassHealth Standard HIPAA Companion Guides located on mass.gov at https://www.mass.gov/lists/masshealth-standard-hipaa-companion-guides.
If you have questions or concerns, please contact MassHealth at (800) 841-2900 or provider@masshealthquestions.com. LTSS providers should contact the LTSS Provider Service Center at (844) 368-5184 or support@masshealthltss.com.