Member Handbook (EOC)
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Medi-Cal
Public program for low income people
CommuniCare Advantage
Medicare and Medi-Cal benefits
Community y Más
Medicare plan for chronic care needs
Provider Disputes
Resources for Providers
Providers
Provider Disputes
In-Network and Out-of-Network providers have the right to dispute Community Health Group’s (CHG) payment or denial of a claim. This includes refund request letters from CHG to a provider.
In-Network Providers may utilize CHG’s Provider Disputes Online Tool to submit disputes. Our Provider Services Specialists are available at 619-240-8933 to assist with any questions on how to use the dispute tool. It’s important to consider the time frame for filing a dispute outlined in your contract.
Out-of-Network providers have 365 calendar days, calculated from the date of the Remittance Advice, within which they may request dispute resolution using the CHG PDR form. For CommuniCare Advantage and Community y Más members, non-contracted providers must submit a completed waiver of liability form to CHG with the completed PDR form.
Include documentation
Please include documentation with your reconsideration, such as the remittance notification showing the denial, all clinical records, or other documentation that supports the provider’s argument for reimbursement.
Out-of-Network providers may submit a request for reconsideration to the address below:
Community Health Group
Provider Disputes Department
2420 Fenton Street, Suite
100
Chula Vista, CA 91914