Claims Appeals & Reimbursements

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

Attention Non-contracted Medicare Providers

Appeals Process for Non-contracted Medicare Providers

Pursuant to federal regulations governing the Medicare Advantage program, non-contracted providers may request reconsideration (appeal) of a Medicare Advantage plan payment denial determination including issues related to bundling or downcoding of services. To appeal a claim denial, submit a written request within 60 calendar days of the remittance notification date and include at a minimum:

_ A statement indicating factual or legal basis for appeal

_ A signed Waiver of Liability form (you may obtain a copy by going to https://www.cms.gov/Medicare/Appeals-and-Grievances/MMCAG/Notices-and-Forms.html, at the bottom of the page under the “Downloads” section select the zip file for ‘Model Waiver of Liability_Feb2019v508’).

_ A copy of the original claim

_ A copy of the remittance notice showing the claim denial

_ Any additional information, clinical records or documentation

YOU ARE REQUIRED TO SUBMIT A WAIVER OF LIABILITY FORM FOR ALL RECONSIDERATION/APPEALS. 

WAIVER OF LIABILITY FORM 

*Please note: United Healthcare does not handle 2nd level disputes. 

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
PO BOX 9030
FARMINGTON, MO 63640-9030
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 6106
CYPRESS, CA 90630  MS: CA124-0157
WWW.UHCONLINE.COM