INLAND EMPIRE HEALTH PLAN IEHP DUALCHOICE P.O. You may use the online appeal submission form below or. HEALTHNET WELLCARE BY HEALTH NET PROVIDER APPEAL P.O. A claim appeal must be filed in writing within 90 days of the date on the EOB or provider remittance. MASON, OH 45040-9398ĬENTRAL HEALTH MEDICARE PLAN PO BOX 14246 ORANGE, CA 92863 *Please note: United Healthcare does not handle 2 nd level disputes.ĭOWNLOAD A PRINTABLE PDF OF ADDRESSES AETNA MEDICARE HEALTH PLAN PO BOX 14067 LEXINGTON, KY 40512 FAX (724)741-4953ĪLIGNMENT HEALTH PLAN ATTN: PROVIDER APPEALS AND DISPUTES PO BOX 14012 ORANGE, CA 92863īLUE SHIELD 65 BLUE SHIELD 65 PLUS HMO PO BOX 927 6300 CANOGA AVENUE WOODLAND HILLS, CA 91365-9856īLUE CROSS SENIOR GRIEVANCES AND APPEALS OH0205-A537 MAIL LOCATION 4361 IRWIN SIMPSON RD. YOU ARE REQUIRED TO SUBMIT A WAIVER OF LIABILITY FORM FOR ALL RECONSIDERATION/APPEALS. You may download a copy by clicking here. Submit a written request within 60 calendar days of the remittance notification Issues related to bundling or downcoding of services. (appeal) of a Medicare Advantage plan payment denial determination including Pursuant to federal regulations governing the MedicareĪdvantage program, non-contracted providers may request reconsideration Process for Non-contracted Medicare Providers If a person other than a beneficiary is requesting for a Direct Member Reimbursement, please download and fill out the “ Appointment of Representative Form.” Submit the completed form along with the request for reimbursement and any pertinent documentation in order to complete the request to: Epic Management LP Attn: Claims Department 1615 Orange Tree Lane Redlands, CA 92374ĬLAIMS APPEALS - LISTING OF MEDICARE HEALTH PLAN APPEAL/PROVIDER DISPUTE ADDRESSESĪttention Non-contracted Medicare Providers
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