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To request a service authorization dispute (medical necessity) please complete the provider service authorization dispute request form, which can be found at .caloptima.org. For routine follow-up regarding claims or PDR status, please contact the CalOptima Health Claims Provider Line at 714-246-8600.
What is the timely filing limit for CalOptima provider appeal?
Reporting and Solving Problems Call our Customer Service department. Fill out the member grievance or appeal form online and click the submit button. Visit our office at 505 City Parkway West, Orange, CA 92868. Fill out the member complaint form or write a letter to CalOptima and mail it to us at the address above.
How to file a grievance with CalOptima?
Definition of a Provider Dispute Challenges a request for reimbursement for an overpayment of a claim. Seeks resolution of a billing determination or other contractual dispute.
What is the difference between a grievance and a healthcare complaint?
The complaint involves a plans decision to invoke an extension relating to an organization determination or reconsideration. The grievance involves a refusal by the plan to grant an enrollees request for an expedited organization determination or expedited reconsideration.
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