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Other Claims Topics

Claim status check

 Your claims: How to check their status and fix rejected ones

Claim filing timelines (timely filing requirements)

For HMO and PPO plans: Within 90 days of the date of service
For Indemnity plans: One year from the date of service

 Timely Filing Guidelines

Claim appeals

Request for Claim Review Form and Reference Guide (masscollaborative.org)

Overpaid claims

Log in and go to Office Resources>Payments & Correspondence.

Claim void/retraction requests

If you want to make request a full void/retraction request, you can submit a replacement claim with frequency code 8.

 Replacement Claim Requirement: Frequently Asked Questions
 Claim Resubmission Guide (Frequency Codes 7 & 8)

Claim processing rules

Log in and go to eTools>Clear Claim Connection.

How long it takes for a claim to process

We process most claims within 30 days of their receipt. However, in some cases, we may need additional information to process your claim. If you don’t receive final payment and claim disposition in a timely manner (within 30-45 days of our receipt of your claim), please use an electronic technology to check your claim’s status.

When we are secondary to Medicare

We have electronic claim crossover arrangements with select Medicare Administrative Contractors. When we are secondary to Medicare, you can eliminate the submission of duplicate claims by first checking claim status after you have received the Medicare Part A/Part B explanation of benefits (EOB). Please allow up to a week after you receive the Medicare EOB to confirm we have the claim.