Dispute Claim Form For Billing Insurance Carriers In Contra Costa
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
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FAQ
Submitting Claims The claim submission timeframe for Contra Costa Health Plan is 180 days from the date of service, or primary explanation of benefits (EOB), for both contracted and non-contracted providers. Claims received after 180 days will be denied for untimely filing.
CCHP was the first federally-qualified, state-licensed, county-sponsored HMO in the United States. In 1973, we became the first county-sponsored health plan in California to offer Medi-Cal managed care coverage and in 1976, we became the first county-run HMO to serve Medicare beneficiaries.
Ways to File a Grievance or Appeal Call Member Services, Monday – Friday, 8am – 5pm at 1-877-661-6230 (Option 2) (TTY 711). If you have a clinically urgent issue, you can also reach our 24 Hour Nurse Advice Line at 1-877-661-6230 (Option 1).
Health Plan of San Joaquin (HPSJ) is a publicly sponsored, local non-profit health care plan designed by and for the people of San Joaquin and Stanislaus counties. HPSJ is available for San Joaquin and Stanislaus county residents for Medi-Cal benefits.
Contra Costa Health Plan (CCHP) follows all applicable Federal and State laws in the use of Telemedicine services to provide consultation, access and quality of care to our Medi-Cal and Commercial members.
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.
