For Providers that are not contracted ("Non-Contracted") with SCAN Health Plan, and your request for claim payment was denied:

• You have the right to request a reconsideration of the plan's denial of payment;
• You have 60 calendar days from the remittance notification date to file the reconsideration;
• You must include a signed Waiver of Liability (WOL) form holding the enrollee harmless regardless of the outcome of the appeal.
• You 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 your argument for reimbursement; and
• You must mail the reconsideration to the plan at the following address:

SCAN Non-Contracted Provider Appeal
PO Box 22644
Long Beach, CA 90801