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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.

Appeals Submission

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 believes the claim, or a portion of the claim, has been denied incorrectly.

Dispute Submission

When submitting a dispute, the provider must submit the claim along with a clear explanation as to why the provider believes the 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 phone number.
  • Original claim number.
  • Patient name and CDCR ID number.

If the dispute is regarding 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.

Providers may check the status of dispute by contacting California Correctional Health Care Services - Disputes.

Last Updated: 06/27/2024