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Dispute Resolution and Appeals

Provider Type

  • Physicians 
  • Hospitals
  • Ancillary

Providers have 180 days from the date a claim is adjudicated to file a dispute or appeal. Providers may submit appeals for the following reasons:

  • The provider believes that the claim was not reimbursed at the contracting rate and additional payment is requested
  • The provider has received a request for reimbursement of an overpayment and the provider believes this is incorrect

When submitting an appeal or dispute, a provider must submit the claim along with a clear explanation as to why the provider believes the payment amount, request for reimbursement of an overpayment, or other action is incorrect. Submit disputes to the California Correctional Health Care Services (CCHCS) Provider Dispute Resolution Department.

The provider dispute must include:

  • Provider's name
  • Provider identification (ID) number
  • Contact information, including telephone number
  • Original claim number
  • Patient name and CDCR ID number

If the dispute is regarding a claim or a request for reimbursement of an overpayment of a claim, the dispute must also include:

  • Clear identification of the disputed item and clear explanation of reason for dispute
  • Date of service
  • Corrected claim, if applicable

Claim corrections due to minor billing errors or omissions do not need to be submitted as provider disputes or appeals. Providers may submit the corrected claim to CorrectCare Integrated Health (CCIH) in the same manner as the original claim. Providers must submit corrected claims within the timely filing period and must follow Centers for Medicare and Medicaid Services (CMS) billing and coding guidelines.

Last Updated: 01/22/2020