CMS non-contracted provider appeal process


Non-contracted providers have the right to request a CMS appeal for denial of payment (zero pay) within 60 calendar days from the remittance notification date. 

A signed waiver of liability form holding the enrollee harmless regardless of the outcome of the appeal is required and must be sent in with all CMS appeal requests.

See the Medicare Managed Manual (MMCM) and waiver of liability form.

CMS waiver of liability form 

A signed form holds the enrollee harmless regardless of the outcome of the appeal.

View form

Information on CMS appeals

When submitting a CMS appeal/reconsideration request, you must include all pertinent documentation to support your appeal.

This can include: 

  • A copy of the original claim
  • Remittance notification showing the denial
  • Any clinical records or other documentation that supports your argument for reimbursement

Please keep in mind that if the waiver of liability is not received along with all supporting documentation when sent to the health plan, your case may be sent for dismissal.

Please submit all CMS appeal and reconsideration requests to the addresses below for the following health plans:


Aetna Medicare Health Plan 

Appeals & Grievance Unit
P.O. Box 14067
Lexington, KY 40512
Fax: 1-866-604-7092


Anthem Blue Cross

Grievances and Appeals
OH0205-A537 Mail Location
4361 Irwin Simpson Road
Mason, OH 45040-9392


Blue Shield 

Appeals & Grievance Unit
P.O. Box 272540
Chico, CA 95927-2540


Health NetTM  Medicare Programs 

Provider Services Department
P.O. Box 10406
Van Nuys, CA 91410


Humana, Inc. 

Appeals and Grievance Unit
P.O. Box 14165
Lexington, KY 40512-4165
Fax: 1-800-949-2961



Appeals and Grievance Unit
P.O. Box 4319
Rancho Cucamonga, CA 91729-4319


SCAN Claims Department 

Appeals & Grievance Unit
P.O. Box 22698
Long Beach, CA 90801-5616



Provider Dispute & Appeals
P.O. Box 30764
Salt Lake City, UT 84130-0764


Alignment Health Plan

Appeals & Grievances Department
P.O. Box 14010
Orange, CA 92863


All other reconsideration requests should be sent to Optum:

Provider Dispute Resolution Department
P.O. Box 6902
Rancho Cucamonga, CA 91729-6902