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Replacement Claims

If you want to make a correction to a previously submitted 1500 or
UB-04 claim, submit a replacement claim.

Unless your claim requires a copy of another insurer’s Explanation of Benefits or Payment, do not send additional documentation or a cover sheet with a replacement claim.

Simply send the claim with the correct Frequency Code/Resubmission Code (see Resources).

If your denied claim has an error

We cannot process a claim correction and an appeal simultaneously. To avoid delays, you should:

  1. Send a replacement claim first. Do not include other documentation.
    • Replacement claim exceptions appear below.
  2. When we issue an updated Provider Detail Advisory, submit an appeal by sending us a completed Request for Claim Review Form with any necessary documentation. This is due within one year of the date the claim was denied.
    • Note: We do not accept appeals by phone.

When NOT to submit a replacement claim

Submit a replacement claim for all corrections except the following. You cannot use replacement claims to:

  • Change or correct the:
    • Billing NPI
    • Date of service (when it falls outside the original date span)
    • Level of care (inpatient to outpatient, or vice versa)
    • Subscriber ID
  • Submit for timely filing review
  • Correct a bridged admission claim
  • Submit claims related to accidental injuries (auto or workers’ compensation)
  • Correct a claim that was part of a previous recovery. Examples:
    • Credit balance
    • Provider audit
    • Claims recovery project

For more information, refer to our Frequently Asked Questions.

Can't submit your replacement claim electronically?

Mail your:

1500 replacement claim to: UB-04 replacement claim to:
Blue Cross Blue Shield of MA
Data Capture
P.O. Box 986020
Boston, MA 02298
Blue Cross Blue Shield of MA
Data Capture
P.O. Box 986015
Boston, MA 02298

Please do not include any additional documentation unless your claim involves Coordination of Benefits.

How to appeal

If you need to appeal rather than correct a denied claim, refer to the Claim Appeal Reference Guide and Form from Mass Collaborative. We do not accept appeals by phone.


Reviews & Appeals

Claim Resubmission Guide (Frequency Codes 7 & 8)
Late Charge Claim Request (Frequency Code 5) Guide
Replacement Claim Requirement: Frequently Asked Questions