PROVIDER DISPUTE RESOLUTION PROCESS

CCHP has a Provider Dispute Resolution (PDR) process that ensures provider disputes are handled in a fast, fair and cost effective manner.

A provider dispute is a written notice from a provider that:

Challenges, appeals or requests reconsideration of a claim (including a bundled group of similar claims) that has been denied, adjusted or contested, or
Challenges a request for reimbursement for an overpayment of a claim, or
Seeks resolution of a billing determination or other contractual dispute.

How to Submit Provider Disputes

Providers must use a Provider Dispute Resolution Request Form (PDF).

You may download Instructions for Submitting Provider Disputes (PDF) or call CCHP Provider Relations at 415-955-8800 for assistance.

Disputes can be mailed to:

Chinese Community Health Plan
Attention: Provider Dispute Resolution Area
445 Grant Avenue, Suite 700
San Francisco, CA 94108

Disputes can be faxed to: 415-955-8815

Acknowledgement of Provider Disputes

CCHP will acknowledge receipt of a provider dispute within 15 business days of receipt.

Resolution Timeframe

CCHP will resolve each provider dispute within 45 business days following receipt of the dispute, and will provide the provider with a written determination stating the reasons for the determination.

Note: To view these documents, you'll need Adobe Acrobat,
which you can download here.