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 see the dispute policies and Provider Dispute Resolution Forms:  

 

 

Brown & Toland Medical Group

Claims Settlement Practices & Dispute Resolution Mechanism

(Commercial)

 

 

Brown & Toland Medical Group

CMS Provider Payment Dispute Resolution Mechanism

 (MA Shared Risk) 

 

 

Brown & Toland Health Services

CMS Provider Payment Dispute Resolution Mechanism

(MA Health Net and MA Scan)

Policy

 BTMG PDR Mechanism

 

 **CMS Provider Payment Dispute Resolution Mechanism

 

 **CMS Provider Payment Dispute Resolution Mechanism

Provider Dispute Resolution Form

BTMG Provider Dispute Resolution Request Form

 

BTMG CMS Provider Dispute Resolution Request Form  

 

BTHS Provider Dispute Resolution Request Form

 

 

By fax: Send electronic requests for payment dispute decisions

 415.972.6011

 415.972.6011

415.972.6011

By Mail: Providers may send hard copy requests to:

Brown & Toland Claims Department
P.O. Box 72710
Oakland, CA 94612-8910 
 
Brown & Toland Claims Department 
P.O. Box 72710
Oakland, CA 94612-8910 
 
BTHS Claims Department 
P.O. Box 70190
Oakland, CA 70190-0190

 

**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). (Applies to CMS Provider Dispute Policy only)

For more information on the CMS PDR process, refer to the CMS Provider Dispute Resolution for non-contracted providers page