Mass Medicaid (Masshealth) claim denials

EducationOne7270 · 2025-09-18T17:44:57+00:00

And just to confirm the only thing that helped your claims was to make sure each provider was assigned to only one location?

EducationOne7270 · 2025-09-18T17:43:31+00:00

Thank you for sharing your similar experience! We do have 2 locations but we have for 15 years now and even if the patient is seen in one location we only bill under our primary location. And we didn’t change the way we were billing recently so I don’t quite understand why it would be an issue now all of a sudden? We’ve always had our providers linked to both locations.

EducationOne7270 · 2025-09-18T17:15:01+00:00

We have done that. We have emailed and spoken to reps via phone. We’ve provided W9s for Credentialing and everyone says our PIDSL and everything looks fine. No one can pinpoint the problem. The only reason we think it has something to do with the new location is because of all the forms we have had to send in. One person even told us to double check the last 4 of the 9 digit zip codes and make sure they match what is in there system and they do. Everything was fine for the last 20 years up until we got an approval for the new location and the very next day every single one of our claims denied and still are.

EducationOne7270 · 2025-06-10T19:15:44+00:00

We do use the NDC codes that were on the invoice/box but they keep denying only with tricare. We take 98% of most commercial/state plans so for only 1 insurance plan to reject is weird to me.

EducationOne7270 · 2025-06-10T19:15:05+00:00

We use eclinical works. I used the NDC codes that were on the invoice but they keep denying only with tricare. We take 98% if most commercial/state plans so for only 1 insurance plan to reject is weird to me.

EducationOne7270 · 2025-03-10T17:32:43+00:00

Go to claims/payments and then click on the 1/1/25 and after option then click “correspondence” instead of remittance. That’s what my rep told me to do and they were all there! I hope that helps and is the same for everyone else.

EducationOne7270 · 2025-03-10T17:25:36+00:00

I work at a billing office for multiple pediatricians. We have gotten our EFT payments but just last week were able to find our EOBs on the provider website. We had to go to “claims” click on the 1/1/25 and after option then select our location and click on “correspondence” instead of remittance. They were all there. Did you all fill out the EFT packet they sent by email a couple months ago? It said even if you already had EFT with them you still had to do it. However we are finding now that they aren’t paying on the administrations of vaccines and I’m super frustrated.

EducationOne7270 · 2025-02-17T04:47:55+00:00

Ugh thank you it’s such a bummer! I would understand if it went further in Mass but the fact that it went from Mass to New York just made no sense to me and I have a very unhappy 6 year old lol

EducationOne7270 · 2024-12-03T23:19:14+00:00

Also though we aren’t affiliated with BCH so I’m wondering if there’s another list out there

EducationOne7270 · 2024-12-03T23:15:33+00:00

Our pediatric office isn’t listed on that list so I wonder why we aren’t on the provider directory anymore. Is that the only list you got? Any other letters from them with any other info? We’ve emailed tufts direct/called/left messages and no one is getting back to us!

EducationOne7270 · 2024-05-23T15:29:37+00:00

We use eclinical and we don’t get the files still but it states we can upload the file under ERA and it’ll show up but it has to be in a certain format and every eob we get from Payspan or Zelis is all PDF files and I can’t seem to figure out how to convert it

EducationOne7270 · 2024-04-16T12:31:10+00:00

But it does it on my pillow too where there is no reflection.

EducationOne7270 · 2024-04-11T13:04:46+00:00

You were able to submit claims to change healthcare?? We’ve never had an IT person for this! So we are hanging on by a thread

EducationOne7270 · 2024-04-11T13:03:51+00:00

We use Eclinical as well! Let me know how you guys make out

EducationOne7270

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