Administrative Reviews and Appeals
Administrative appeals or claims reviews are conducted on claim denials.
If you’d like to:
- Request a claim adjustment for a service previously reviewed, you must submit a written request to the address listed below.
- Make a correction to a previously submitted 1500 or UB-04 claim, then submit a replacement claim, not an appeal.
- Submit an appeal, send us a completed Request for Claim
Review Form.
This is due within one year of the date the claim was denied. You can submit up to two appeals for the same denied service within one year of the date the claim was denied.
Where to mail your completed documents
| Medical appeals | Dental appeals |
|---|---|
| Blue Cross Blue Shield of MA Provider Appeals PO Box 986065 Boston, MA 02298 |
Blue Cross Blue Shield of MA Process Control PO Box 986010 Boston, MA 02298 |
Appeals we’re currently reviewing
| For | We are currently processing appeals received on this date |
|---|---|
| Medicare Advantage | 05/26/2023 |
| BlueCard (outside Massachusetts) | 05/24/2023 |
| Home Infusion Therapy | 05/15/2023 |
| In-state (local), professional 1500 | 05/22/2023 |
| In-state (local), facility UB-04 | 05/18/2023 |
| Federal Employee Program - 1500 | 05/15/2023 |
| Federal Employee Program - UB-04 | 05/15/2023 |
| Timely Filing Limit | 05/09/2023 |
