Provider Central

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

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:

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.

Resources

Reviews & Appeals