Right of Reconsideration for Non-contracted Providers

  • Non-contracted providers have the right to request a reconsideration of the plan’s denial of payment;
  • Non-contracted providers have 60 calendar days from the remittance notification date to file the reconsideration;
  • Non-contracted providers must include a signed Waiver of Liability form holding the enrollee harmless regardless of the outcome of the appeal. A copy of this waiver of liability form can be obtained at the following links: 
    http://www.humana.com/resources/support_center/forms.aspx 
    http://www.ibx.com/pdfs/providers/claims_and_billing/medicare_appeal/waiver_of_liability_statement.pdf 
  • Non-contracted providers should include documentation such as a copy of the original claim, remittance notification showing the denial, and any clinical records and other documentation that supports the provider’s argument for reimbursement; 
  • Non-contracted providers must mail the reconsideration to the member’s health plan at the addresses listed below:

Health Net Medicare Programs Provider Services Department
Medicare Appeals and Grievances
P.O. Box 10406
Van Nuys, CA 91410-0406
         
Humana Inc.
Appeals and Grievance Department
PO Box 14165
Lexington, KY 40512-4165
Fax 1-800-949-2961

OneCare Attention: Grievance and Appeals Resolution Services
505 City Parkway West
Orange, CA 92868
Fax Number 714-246-8562

SCAN Non-Contracted Provider Appeal
PO Box 22698
Long Beach, CA  90801