CMS provider disputes

Pursuant to federal regulations governing the Medicare Advantage program, 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, including issues related to bundling of services. 

To dispute a claim payment, submit a written request within 120 calendar 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 
• Dispute form

If you have additional questions relating to a dispute decision made, you may 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 have the option to request a Health Plan dispute review. The request for Health Plan Dispute Review must be received within 120 calendar days from the determination date of the initial dispute.

HMO addresses

Please send all dispute requests in writing, accompanied by all documentation to support your position, directly to the Provider Appeals and Disputes team by using the HMO address/addresses listed below.