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Reprocess/Adjustments For Professional Claims Denied With Edit 4801 ‘Procedure Not Covered By Provider Contract’

September 13, 2021

MassHealth identified that certain professional claims billed by acute outpatient hospitals and hospital licensed health centers were inadvertently denied for edit 4801 ‘Procedure Not Covered by Provider Contract’ from October 2020 through August 2021. This issue has been corrected and the affected claims have been reprocessed/adjusted. All reprocessed/adjusted claims will appear on this and subsequent remittance advices.

If you have questions, please contact the MassHealth Customer Service Center at providersupport@mahealth.net or (800) 841-2900.