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Appealing a denial? Use our code for faster claim review
September 26, 2019

This article is intended for all hospitals and physicians. This is for claims that are not required to go through the replacement claims process.

When you’re using the Request for Claim Review form to appeal a denied claim, please include the Blue Cross Blue Shield of Massachusetts denial code in the required field indicated below. This will help us quickly route your request, based on the type of denial you received.

Where do you enter this information on the Request for Claim Review Form?


Where can you find the Blue Cross denial code?

We recommend using PaySpan, our electronic payment vendor, as the best way to view your Provider Detail Advisory. Both Blue Cross and HIPAA message codes can be found beneath the Grand Totals line.

  • Blue Cross messages are displayed using all upper case.
  • At the end of each message, you’ll see the code to include on the Request for Claim Review form.
  • Our codes generally consist of an alpha character followed by three numbers (as shown in the example below).

Sample Provider Detail Advisory showing X585


Why should you use the Blue Cross code rather than the HIPAA code?

Using the Blue Cross message helps us get your appeal to the right department quickly to review the request. Using HIPAA codes will delay your request.

Reminders

  • Your appeal must be submitted within one year of the date the claim was processed.
  • You can submit up to two appeals per denied service within one year of the process date.
  • Completed forms should be mailed to:

Blue Cross Blue Shield of Massachusetts
Provider Appeals
P.O. Box 986065
Boston, MA 02298

Resource

 Quick Tip: How to correct rejected and paid claims

MPC_082319-2P-1

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