According to federal regulations that govern Medicare Advantage plans, non-contracted providers may file a payment dispute for a Medicare Advantage plan payment determination.
A payment dispute may be filed when the provider disagrees with the amount paid.
To dispute a claim payment, submit a written request within 120 days of the remittance notification date and include, at a minimum:
- A statement indicating factual or legal basis for the dispute
- A copy of the original claim
- A copy of the remittance notice showing the claim payment
- Any additional information, clinical records or documentation to support the dispute
If you have more questions about a dispute decision, contact us at:
Phone: 1-800-956-8000
Fax: 1-866-929-7165
Mail: PDR Department
P.O. Box 6902
Rancho Cucamonga, CA 91729-6902
If you do not agree with the dispute determination, you can request a Health Plan dispute review. A dispute review must be received within 180 days from the determination date of the initial dispute.
HMO addresses
Send dispute requests in writing and include all documentation to support your position. Send them to the Provider Appeals and Disputes team at the HMO addresses listed below.
Aetna Medicare Health Plan Appeals and Grievance Unit
Aetna Medicare Health Plan Appeals & Grievance Unit
P.O. Box 14067
Lexington, KY 40512
Fax: 1-866-604-7092
Alignment Health Plan
Appeals and Grievance Department
P.O. Box 14010
Orange, CA 92863
Anthem Blue Cross
Grievances and Appeals
OH0205-A537 Mail Location
4361 Irwin Simpson Road
Mason, OH 45040-9392
Blue Shield
Appeals and Grievance Unit
P.O. Box 272540
Chico, CA 95927-2540
Brand New Day & Central Health Plan
Medicare Appeals
PO Box 66588
St. Louis, MO 63166-6588
Fax: 1-877-852-4070
Humana, Inc.
Appeals and Grievance Unit
P.O. Box 14165
Lexington, KY 40512-4165
Fax: 1-800-949-2961
IEHP
Appeals and Grievance Unit
P.O. Box 4319
Rancho Cucamonga, CA 91729-4319
SCAN Claims Department
Appeals and Grievance Unit
P.O. Box 22698
Long Beach, CA 90801-5616
Sharp Health Plan
Grievances and Appeals
8520 Tech Way, Ste 200
San Diego, CA 92123
Fax: 1-619-740-8572
UnitedHealthcare
Provider Appeals
MS:CA124-0157
P.O. Box 6106
Cypress, CA 90630
UnitedHealthcare
CMS Provider Disputes
P.O. Box 30997
Salt Lake City, UT 84130-0997
WellCare by Health Net Medicare Programs
Provider Services Department
P.O. Box 10406
Van Nuys, CA 91410