Reimbursement
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 92374
CLAIMS APPEALS - LISTING OF MEDICARE HEALTH PLAN APPEAL/PROVIDER DISPUTE ADDRESSES
YOU ARE REQUIRED TO SUBMIT A WAIVER OF LIABILITY FORM FOR ALL RECONSIDERATION/APPEALS. MANY OF THE HEALTH PLANS HAVE THEIR OWN UNIQUE FORM, PLEASE VISIT THE APPROPRIATE HEALTH PLAN WEBSITE TO OBTAIN THE OFFICIAL DOCUMENT.
wAIVER
OF LIABILITY FORM CAN ALSO BE OBTAINED ON THE CMS WEBSITE AT THE FOLLOWING
ADDRESS: https://www.cms.gov/Medicare/Appeals-and-Grievances/MMCAG/Downloads/Appendix-7-Waiver-of-Liability-Notice.pdf
DOWNLOAD A PRINTABLE PDF OF ADDRESSES
AETNA MEDICARE HEALTH PLAN
PO BOX 14067
LEXINGTON, KY 40512
FAX (866) 604-7092
ALIGNMENT HEALTH PLAN
P.O. BOX 14010
ORANGE, CA 92863-9936
BLUE SHIELD 65
BLUE SHIELD 65 PLUS HMO
PO BOX 927
6300 CANOGA AVENUE
WOODLAND HILLS, CA 91365-9856
BLUE CROSS SENIOR
GRIEVANCES AND APPEALS
OH0205-A537 MAIL LOCATION
4361 IRWIN SIMPSON RD.
MASON, OH 45040-9398
CENTRAL HEALTH MEDICARE PLAN
1540 BRIDGEGATE DR. MAIL STOP 3000
DIAMOND BAR, CA 91765
HEALTHNET
HEALTH NET MEDICARE PROGRAMS PROVIDER SERVICES DEPARTMENT
PO BOX 10406
VAN NUYS, CA 91410-0406
HTTP://WWW.HEALTHNET.COM
HUMANA INC. APPEALS AND GRIEVANCE DEPARTMENT
PO BOX 14165
LEXINGTON, KY 40512-4165
FAX # (800) 949-2961
INLAND EMPIRE HEALTH PLAN
IEHP DUALCHOICE
P.O. BOX 1800
RANCHO CUCAMONGA, CA 91729-1800
INTER-VALLEY HEALTH PLAN
PO BOX 6002
POMONA, CA 91769
ATTN: PROVIDER APPEALS
SCAN HEALTH PLAN
PO BOX 22698
LONG BEACH, CA 90801
UNITED HEALTHCARE
PO BOX 30997
SALT LAKE CITY, UT 84130-7604
WWW.UHCONLINE.COM