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Web review type to submit claims for review to masshealth. Web universal request for claim review form for providers. Web this standard form may be utilized to submit a claim to a health plan or masshealth for additional review. An accompanying reference guide provides valuable. In an effort to streamline the claims review process for providers, a new form is available. Web dental network application diagnostic imaging professional privileging application electronic remittance advice enrollment form (submit online) endovenous ablation. An accompanying reference guide provides valuable. Web this standard form may be utilized to submit a claim to a health plan or masshealth for additional review. Use of this form for submission of claims to masshealth is restricted to claims with service dates exceeding one.