CMS Physician Dispute Resolution

Effective January 1, 2010, the Centers for Medicare & Medicaid Services (CMS) will expand its current provider payment dispute resolution process for disputes between non-contracted and deemed providers and Private Fee for Service Plans (PFFS) to include disputes between non-contracted providers and all:
 
  • Medicare Advantage Organizations (HMO, PPO, RPPO and PFFS)
  • 1876 Cost Plans
  • Medi-Medi Plans
  • Program of All-Inclusive Care for the Elderly (PACE) organizations
First Level Review
Providers should send their provider dispute request to Brown & Toland for a first level review.

Please fill out the provider dispute resolution request form and submit the form to Brown & Toland Physicians. 

  • By fax: Send electronic requests for payment dispute decisions to 415.972.6011.
  • By mail: Providers may send hard copy requests to:
Brown & Toland Physicians Claims Department 
P. O. Box 72719
Oakland, CA 94612-8910
 
 
Submission of a first-level provider dispute must be filed within a minimum of 120 calendar days after the notice of initial determination (i.e., Explanation of Benefits/Remittance Advice).
 
For more information on the PDR process, refer to the CMS Provider Dispute Resolution for non-contracted providers page