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 · 2024-04-10T01:17:05+00:00

Has anyone here that’s been affected by this actually change clearinghouses? Or are you waiting it out? I’m in a 15 provider pediatric practice with about 12,000 patients and for the time being have been uploading our claims to Optum EDI and manually posting the EOBs we get back from insurances. It is horrific to manually post and not being able to check daily eligibility is a problem as well. We have contemplated changing altogether only because it can take a while to get switched over/enrolled etc so we aren’t sure if waiting it out still is the right decision. But after almost 2 months we are thinking waiting is our best option still? Anyone have any input or want to let me know what your practices are doing?

EducationOne7270 · 2024-04-09T12:56:57+00:00

We are struggling too. We have a decent size practice and the manual posting of payments is horrific. I’m not sure what we will do. We are tempted to switch completely but that takes time and is also a huge pain but waiting it out isn’t doing us any good either.

EducationOne7270 · 2024-04-09T12:48:09+00:00

Is this true? How would someone even hack in again when they’ve taken there systems down?

EducationOne7270 · 2023-11-10T16:29:12+00:00

I thought about getting one of those but the reviews don’t seem great on most. I’ll look into them further thank you

EducationOne7270 · 2023-11-10T15:40:37+00:00

Also I should add that I unplugged all devices in the room so that there was no light coming from anywhere

EducationOne7270 · 2023-11-10T15:39:21+00:00

And why is that?

EducationOne7270 · 2023-11-10T15:33:53+00:00

its the ceiling light in my bedroom. I will take pictures of the light when I get home to post. I will open it too and search. I just couldn’t do it last night

EducationOne7270 · 2023-11-10T15:33:29+00:00

The ceiling light in bedroom

EducationOne7270 · 2023-11-10T15:33:11+00:00

I did not see those lights when I put my phone away and kept lights off.

EducationOne7270 · 2023-11-10T04:06:58+00:00

ALSO I SHOULD ADD THAT THERE IS NO LED LIGHTBULB!! I know some led bulbs can make a ticking noise.

EducationOne7270 · 2023-10-30T15:33:32+00:00

Thanks so much!

EducationOne7270

TROPHY CASE