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.
Aetna Medicare Health Plan
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 Rd
Mason, OH 45040-9392
Blue Shield
Appeals & Grievance Unit
P.O. Box 272540
Chico, CA 95927-2540
UnitedHealthcare
Provider Appeals
MS:CA124-0157
P.O. Box 6106
Cypress, CA 90630
Care 1st
Attn: PDR Department
P.O. Box 3829
Montebello, CA 90640
Easy Choice Health Plan, Inc.
Appeals & Grievance Unit
P.O. Box 260519
Plano, TX 75026-0519
Health NetTM Medicare Programs
Provider Services Department
P.O. Box 10406
Van Nuys, CA 91410
UnitedHealthcare
CMS Provider Disputes
P.O. Box 30997
Salt Lake City, UT 84130-0997
Humana, Inc.
Appeals & Grievance Unit
P.O. Box 14165
Lexington, KY 40512-4165
Fax: 1-800-949-2961
IEHP
Appeals & 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