Submission Agreement Sample With Service Provider In Contra Costa
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I authorize the release of my medical information necessary to process this claim. Select 'Print' to mail your completed form and itemized bill to: Medical Mutual, P.O. Box 6018 Cleveland OH 44101-1018. Select 'Submit' to send your completed form in an email message.
Paper Claims Submission Please send your paper claims to: CCHP Claims Department, Post Office Box 1599, San Leandro, CA 94577.
Please send your paper claims to: CCHP Claims Department, Post Office Box 1599, San Leandro, CA 94577.
You can also file an Appeal in writing, at: Louisiana Healthcare Connections, P.O. Box 84180, Baton Rouge, LA 70884. Or you can fax your Appeal to 1-877-401-8170. Louisiana Healthcare Connections will acknowledge your Appeal within five (5) days of receiving it.
CCHP is the primary managed-care provider for Medi-Cal beneficiaries in Contra Costa and we also manage smaller plans for county employees and IHSS homecare workers. Our members have access to hundreds of family medicine doctors and specialists in our provider networks.
Submitting Claims Claims received after 180 days will be denied for untimely filing.
You may also call CCHP Customer Care at (800) 893-1598 or Covered California at (800) 300-1506.
Send your claim form and documentation to: Mail: HealthSmart Benefit Solutions, Inc. PO BOX 1014 Charleston, WV 25324-1014 Fax: 806.473. 2535 Online: healthsmart/nysut.
