With the development of waste recovery techniques, previous research has revealed that coarse fractions of municipal solid waste incineration (MSWI) bottom ash (BA) after proper treatment could be applied in the construction sector, while the fines are seldom recovered in practice and normally landfilled. This study explores the potential application of fine MSWI BA (0–2 mm) as a supplementary cementitious material (SCM) in Portland cement (PC) mixtures. Mechanical and chemical pre-treatment approaches have been designed with various conditions to optimize the treating process. The chemical and mineralogical compositions, as well as the metallic Al content in BA were characterized before and after the pre-treatment. It was found that both methods are effective in removing the metallic Al content in BA, Moreover, BA derived from mechanical treatment exhibited more contribution to the hydration reaction in PC mixtures, as revealed by the amount of reaction products and mineral phases formed in hardened trial mixtures. BA obtained was further partially blended in PC mortars to evaluate the performance as compared to SCMs and inert fillers. It was found that treated BA resulted in a slight retarding effect on the reaction kinetics. Treated BA behaved better than the coal fly ash to contribute to the strength development, while the inclusion of BA did not lead to significant influences on the workability.