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Claim Submission

Here’s some information on how to submit claims to us.

 For additional details and links to tools to check the status of your claims, log in and go to Office Resources>Claim Submission.

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Submitting a claim

Electronic submission
We recommend electronic claim submission for the most efficient processing. Be sure to enter the member’s ID exactly as it appears on the member’s ID card, including the prefix and all subsequent digits. Please make sure that your claim submission systems can accommodate a member ID with at least 17 characters, and alpha and numeric combinations. All electronic claim submissions can now accept up to 50 lines per claim.

Here are some options for submitting claims electronically:

  • Direct connection (set up required)
  • Through a clearinghouse
  • Direct Data Entry using Online Services. (For CMS-1500 billers, we offer this tool through our website.
     Log in and go to eTools>Online Services.)

To get started, call our EDI Support Team at 1-800-771-4097 Option 2 or email EDISupport@bcbsma.com.

For more options, call Change Healthcare™ at 1-800-266-2206

Guidelines
Make sure you access the latest version of these guidelines. Revisions we make are noted on the last page of each document.


Paper submission

Mail the CMS-1500 form to: Mail the UB-04 form to: Mail the ADA 2012 form 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
Process Control
Blue Cross Blue Shield of MA
P.O. Box 986005
Boston, MA 02298

Guidelines
 1500 Billing Guidelines for Professional Providers

For UB-04 billing guidelines, go to the National Uniform Billing Committee or American Hospital Association websites.

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.

Submitting a replacement claim

If your claim is partially or fully denied and you want to make a correction, you can submit a replacement claim (no supporting documentation1 needed) to:

  • Correct the date of service, diagnosis, procedure, or modifiers
  • Correct patient data (some exceptions2 apply)
  • Make changes to your original claim, plus add new charges for services not previously submitted
  1. Supporting documentation, such as a Provider Detail Advisory (PDA), is not required.
  2. Do not submit a replacement claim to change the subscriber ID number. For other exceptions, refer to our Frequently Asked Questions.

Learn more about replacement claims
 Replacement Claim Requirement: Frequently Asked Questions
 Claim resubmission guide (frequency codes 7 & 8)
 Late Charge Claim Request (Frequency Code 5) Guide

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

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.

Tracking claims

Tracking your claims will help prevent denials for exceeding the timely filing guidelines.

Direct Data Entry
Our Quick Tip, How to view Direct Data Entry reports in Online Services, explains how to set up your report preferences and create reports if you use Online Services to submit 1500 claims. Follow the steps in the Quick Tip every time you submit claims and receive a batch number.

EDI Claim Reports
If you or your clearinghouse submit claims as HIPAA-compliant 837 files, we recommend that you retrieve and review your:

  • File Detail Summary Report (277CA Report)
  • Batch and Claim Level Rejection Report (the “Submitter PDF report”)
    • The report will tell you the number of claims that were:
      • Submitted
      • Accepted
      • Rejected and why.
  • Functional Acknowledgement (999 Report)
  • Interchange Acknowledgement (TA1)

For more information on these reports, refer to our direct connection resource, 837 Transactions - Companion Guide for Health Care Claims.

Tips:

  • Retain all reports you receive from your electronic claim submission to track receivables and identify potential problems.
  • Resubmit corrected claims electronically. Note: Do not use frequency code 7 for claims adjudication/resubmission of claims that were rejected on the EDI front end. You must resubmit this type of claim as a new-day claim, with claim frequency = 1 (CLM05-3).
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 (refunds and remittances)

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

Claim processing rules (how our claims editing software processes claims)

Log in and go to eTools>Clear Claim Connection.

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