How to Submit Claim Disputes & Appeals
Payment disputes and appeals processes for contracted providers are governed by the terms of the contract between the Provider and SCAN. Participating providers should refer to their participating provider agreement and applicable Provider Operations Manual for information on specific provider claim review or appeal rights.
To submit a dispute, complete the appropriate PDF form below, save it and fax it to SCAN:
- Reopening Request Form: Use this form for SCAN processed claims
- Payment Dispute Resolution (PDR) Form: Use this form for Non-Contracted Provider Payment disputes
- Provider Delegate Claim Dispute Resolution Form: Use this form when requesting SCAN assistance with Delegate disputes
The preferred and most efficient method to submit Claim Disputes to SCAN is by Fax.
- Fax Disputes and any attachments to (562) 997-1835
- If unable to fax, mail the form and supporting documents to: SCAN Health Plan, Attn: SCAN Claims Provider Disputes, P.O. Box 22698, Long Beach, CA 90801-9826
Please allow the following processing times for disputes:
- Thirty (30) calendar days for non-contracted providers for fee schedule payment disputes, billing errors, and minor corrections
- Forty Five (45) calendar days for Medicaid
- Sixty (60) calendar days for contracted providers
Claim Appeals - Reconsiderations for Medical Necessity Denials (Special Rules for Non-Contracted Providers):
- Non-Contracted Providers may request an appeal within sixty (60) calendar days of receipt of Remittance Advice (RA).
- The appeal request must include a signed Waiver of Liability (WOL) form, documentation supporting the request (e.g., copy of RA notice, medical records, and copy of the claim). The WOL form holds the member harmless regardless of the outcome of the appeal.
- The preferred and most efficient method to submit appeal to SCAN is by Fax.
- Fax the completed WOL form and any attachments to (562) 989-0958
- If unable to fax, mail the completed WOL form and any documentation to: SCAN Health Plan, Attn: SCAN Non-Contracted Provider Appeals, P.O. Box 22644, Long Beach, CA 90801-9826
- Please allow Sixty (60) days for processing time for Non-Contracted Provider Appeals. The adjudication timeframe begins when the WOL is received by the plan.