Download Appeal Rights for Non-Participating Providers

 Appeal Rights for Non‐Participating Providers
Non-participating providers can dispute the amount paid by Providence Medicare
Advantage Plans for a covered service if they believe they were paid less than the amount
that would have been paid by original Medicare. This can be done by requesting a first
level review. Provider payment disputes also include instances where there is a
disagreement between a non-participating provider and Providence Medicare Advantage
Plans about the plans decision to pay for a different service than billed, often referred to
as down-coding of claims. Providers have 120 days from the date of claim determination to
make a request for a first level review.
All non-participating providers who have requested redetermination will be advised in
writing of the outcome of Providence Medicare Advantage Plans first level review.
Please note: The expansion of the provider payment dispute resolution process does not
include Part D claims.
You can request a first level review by doing one of the following:
Call:
Providence Medicare Advantage Plans Customer Service Team
503-574-8000 or 1-800-603-2340
Monday through Friday, between 8 a.m and 5 p.m (Pacific)
Write:
Providence Health Plan
Attn: Providence Medicare Advantage Plans Service Team
P.O. Box 5548
Portland, OR 97228-5548