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CMS non-contracted provider appeal process

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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 Care 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 any and 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/reconsideration requests to the addresses below for the following health plans:

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Aetna Medicare Health Plan 

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

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Anthem Blue Cross

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

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Blue Shield 

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

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Care 1st

Attn: PDR Department
P.O. Box 3829
Montebello, CA 90640

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Easy Choice Health Plan, Inc. 

Appeals & Grievance Unit
P.O. Box 260519
Plano, TX 75026-0519

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Health NetTM  Medicare Programs 

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

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Humana, Inc. 

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

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IEHP 

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

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SCAN Claims Department 

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

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UnitedHealthcare

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

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All other reconsideration requests should be sent to NAMM:

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