When we request an adjustment on paper for a claim that was paid by the old claims processing system, MassHealth has been recouping the entire claim instead of adjusting it. Why?
Providers need to carefully check the adjustment section of the remittance advice for both header and line detail EOB (explanation of benefits) codes. If an EOB code is listed in either field, then there was an error on the submitted adjustment claim. If an adjustment is submitted and there is an error on the replacement claim, MassHealth will recoup the original payment and deny the replacement claim. You will need to resubmit the claim with the correction as noted in the EOB code listed on the remittance advice.
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