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

Providers should send their provider dispute request to Brown & Toland for a first level review.

Please fill out the following provider dispute resolution request form.

Please 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
P. O. Box 640469
San Francisco, CA 94164-0469

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).

A non-contracted provider may submit a written request for an Independent Payment Dispute Decision (PDD) to C2C Solutions, Inc. (C2C) by e-mail, fax or mail within 180 calendar days of written notice from the payer. For more information, please visit www.c2cinc.com.

Refer to the CMS Provider Dispute Resolution page.