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What to do when a claim rejects

If we reject a claim because we are not primary, you must submit the claim to the primary insurer.

Medical claims

When you receive the other insurer’s explanation of benefits, submit a replacement claim. We must receive the replacement claim within one year of the date the other insurer processed the claim.

You can submit the replacement claim electronically. Be sure to follow instructions for replacement claims and Coordination of Benefits claims. If you are sending a paper claim, attach the other insurer’s EOB and mail it to the appropriate address.

How to appeal a Massachusetts COB claim denial

If we reject your claim because we are not the primary insurer, follow the replacement claim process described above. However, if your Blue Cross Blue Shield of Massachusetts COB claim was denied for another reason and you disagree with the denial, send a Request for Claim Review Form and any required documents by:

Fax: 1-617-246-5032

Or mail:

Blue Cross Blue Shield of MA
Coordination of Benefits
One Enterprise Drive
Quincy, MA 02171-2126

BlueCard (out-of-state) COB appeals should be mailed to the claims address for Professional or Institutional claims.

Dental claims

When you receive the other insurer’s Explanation of Benefits, send us a Request for Claim Review Form and the other insurer’s EOB. Mail your documents to the address for Dental appeals:

Blue Cross Blue Shield of MA
Process Control
PO Box 986010
Boston, MA  02298

Note: We must receive the appeal within one year of the date the other insurer processed the claim or within two years from the date of service.

If you have questions about benefits or claim adjustments, please call Dental Provider Services at 1-800-882-1178, Option 3

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