Provider Dispute Resolution

Asset 2

Reconsiderations & Appeals

If a provider wishes to dispute a claim payment or denial (for reasons not related to a submission error or omission) the provider can submit a written dispute to the following address.

Community Health Center Network
Attn: Appeals Department
101 Callan Avenue, Suite 300
San Leandro, CA 94577

Click here for the Provider Dispute Resolution form for a single claim. For submission of a Provider Dispute Resolution for multiple/like claims click here.

Specific details are required. See the Provider Payment Dispute Resolution Guidelines for Medicare patients here. For all other patients click here to view the guidelines.

Reconsiderations and Appeals

Non-contracted providers who wish to request a reconsideration for a claim denied for Medicare Services rendered may submit a written request to the following address. Non-contracted providers must also submit a signed copy of the Waiver of Liability. A printable version of the Waiver of Liability may be found here.

**HIPAA regulations require that patient identifiable health information be protected. Click here for a list of what is considered Protected Health Information.**