Provider Claims Disputes
A provider claim dispute is a written notice to CHCN challenging, appealing or requesting reconsideration of a claim (or a bundled group of substantially similar multiple claims that are individually numbered) that has been denied, adjusted or contested or seeking resolution of a
billing determination, or disputing a request for reimbursement of an overpayment of a claim. If a provider wants to dispute a claim payment or denial (for reasons not related to provider’s claim submission error or omission) the provider can submit a written dispute to the following
Address:
Community Health Center Network
Attn: Provider Claims Dispute Department
101 Callan Avenue, Suite 300
San Leandro, CA 94577
510.297.0210
Note: Claims that are denied due to provider’s claim submission error or omission (e.g. missing/incorrect CPT, ICD-10-CM or place of service codes) or any changes in the claim form made from original submission do not qualify for the Provider Claim Dispute Resolution Mechanism. Claims resubmission with medical records for review due to bundling edits, included services, request for medical records/treatment notes, anesthesia time spent or EOB submissions should be sent directly to claims dept. not through provider disputes. These should be resubmitted within the time period for claim submission.
For PDR guidelines and PDR submission form click here.