Physician Dispute Resolution

For the following Brown & Toland Medical Group claims, please send to:

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

By Fax: Send electronic requests for payment dispute decisions to 415.972.6011

For the following Brown & Toland Health Services claims, please send to:

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

By Fax: Send electronic requests for payment dispute decisions to 415.972.6011

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.