Non-Contracted Provider Notice of Appeals Rights
Non-contracted providers have the right to request a reconsideration of Community Health Group’s denial of payment. In order to request a reconsideration, a non-contract provider must submit a Waiver of Liability form holding the enrollee harmless regardless of the outcome of the appeal. Click this link to access form: CMC Waiver of Liability Form. Non-contracted providers have 60 calendar days from the date of this remittance advice to request a reconsideration.
Please include documentation with your reconsideration, such as a copy of the original claim or remittance notification showing the denial, and all clinical records or other documentation that supports the provider’s argument for reimbursement.
Please submit your request for reconsideration to the address below:
Community Health Group
Provider Disputes Department
2420 Fenton Street, Suite 100
Chula Vista, CA 91914
Community Health Group only honors Contract Applications from the following providers at this time. If you are one of these providers, please click on the applicable specialty below for the corresponding application:
Notice to Non-Contracted Providers