Physician Dispute Resolution

 

Brown & Toland Medical Group

Claims Settlement Practices & Dispute Resolution Mechanism

(Commercial)

Brown & Toland Medical Group

Medicare Advantage Claims Inquire Process for Contracted Partners

Brown & Toland Medical Group

CMS Provider Payment Dispute Resolution Mechanism (Non-Contracted Providers)

 (MA Shared Risk) 

 

Brown & Toland Health Services

Medicare Advantage Claims Inquiry Process for Contracted Providers Mechanism

 

Brown & Toland Health Services

CMS Provider Payment Dispute Resolution Mechanism  (Non-Contracted Providers)

(MA Health Net and MA Scan)

Policy

BTMG PDR Mechanism

BTMG Medicare Advantage Claims Inquiry Process for Contracted Providers

**CMS Provider Payment Dispute Resolution Mechanism (non-contracted providers)

BTHS Medicare Advantage Claims Inquiry Process for Contracted Providers

**CMS Provider Payment Dispute Resolution Mechanism (non-contracted providers)

Provider Dispute Resolution Form

BTMG Provider Dispute Resolution Request Form

BTMG Provider Claim Reconsideration Request Form

BTMG CMS Provider Dispute Resolution Request Form

BTHS Provider Claim Reconsideration 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

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 

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

BTHS Claims Department
P.O. Box 70190
Oakland, CA 70190-0190

BTHS Claims Department
P.O. Box 70190
Oakland, CA 70190-0190

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. 

**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 (non-contracted) only)

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