EOHHS-MassHealth

Select all transaction type(s) with which you are experiencing issues:

271 - Healthcare Eligibility Response

277 - Health Care Claim Status Response

835 - Healthcare Claim Remittance Advice

999/TA1 - Acknowledgement Transaction

Enter date the file was expected

Clearly describe the issues you are experiencing when attempting to retrieve the response file(s):

Enter the provider information below:

DBA (“Doing Business As”) address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

MassHealth PID/SL (“Provider ID/Service Location)

PID/SL consists of 10 characters: a 9-digit base number followed by an alphabetic service location letter (e.g., 123456789A)

Name

First Last

Phone

Submitter User Name