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Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealthMassHealth Transmittal Letter DEN96 June 2016 TO: FROM: RE:Dental Providers Participating

How to fill out masshealth transmittal letter den-96

How to fill out the MassHealth Transmittal Letter DEN-96:

1. Start by entering the date on the top right corner of the letter. Make sure to use the proper date format (e.g., MM/DD/YYYY).
2. Fill in the recipient's information in the "To" section of the letter. Include their name, title (if applicable), and the name of their organization or department.
3. In the "From" section, enter your own information as the sender. Include your name, title (if applicable), and the name of your organization or department.
4. Write a brief and clear subject line that summarizes the purpose of the letter.
5. Begin the body of the letter with a formal salutation, such as "Dear [Recipient's Name]," or "To Whom It May Concern," if the recipient's name is not known.
6. Clearly state the purpose of the letter in the opening paragraph. For example, if you are appealing a denied claim, mention that you are writing to appeal the denial for a specific medical service or treatment.
7. Provide a detailed explanation of the reasons why you believe the denial should be overturned. Include any relevant documentation or evidence, such as medical records, test results, or supporting letters from healthcare professionals.
8. Offer a concise and logical argument in support of your appeal. Use specific examples or reference applicable laws or guidelines that support your case.
9. In the closing paragraph, summarize your main points and reiterate your request for the denial to be reversed. Thank the recipient for their time and consideration.
10. End the letter with a professional closing, such as "Sincerely," or "Thank you."

Who needs MassHealth Transmittal Letter DEN-96?

MassHealth Transmittal Letter DEN-96 may be needed by individuals or organizations who are appealing a denied claim or seeking to reverse a denial for a specific medical service or treatment. This letter is typically used to communicate with MassHealth, the Massachusetts Medicaid program, and provide a formal appeal or request for reconsideration.

It is important to consult MassHealth's guidelines or reach out to their customer service for specific eligibility requirements and instructions on when and how to submit the Transmittal Letter DEN-96.

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