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CMS provider disputes

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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.

 

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Aetna Medicare Health Plan 

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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UnitedHealthcare 

Provider Appeals
MS:CA124-0157
P.O. Box 6106
Cypress, CA 90630

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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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UnitedHealthcare

CMS Provider Disputes
P.O. Box 30997
Salt Lake City, UT 84130-0997

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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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