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)