Claims Disputes & Appeals
Disagree with a claims decision?
Submit an appeal (non-contracted providers only)
To request an appeal of a medical necessity denial, non-contracted providers should submit a request within 60 calendar days of receipt of Remittance Advice. This request should include:
- A signed Waiver of Liability (WOL) Form
- A copy of the original claim
- The remittance notification
- Any clinical records and other supporting documentation
Submit the request via fax to (562) 989-0958. If unable to fax, mail it to:
SCAN Health Plan
Attn: SCAN Non-Contracted Provider Appeals
P.O. Box 22616
Long Beach, CA 90801-9826
Check the status of a dispute or appeal
Call Provider Services at (888) 540-7226 (note: allow 60 calendar days prior to calling)
Forms
Complete the appropriate dispute form below:
- Reopening Request Form to correct a coding error or omission
- Provider Dispute Resolution (PDR) Form for all other disputes
