Doctors HealthCare Plans, Inc. Your Health, Our Commitment
 2020 Ponce de Leon Blvd, Suite PH 1, Coral Gables, FL 33134   
  

Claim Appeals for Non-Participating Providers

 

Non-Participating providers may submit a Claim Appeal within sixty (60) calendar days from the date of the corresponding Remittance Advice. Claim Appeals submitted past sixty (60) days from the date of the corresponding Remittance Advice will be considered a late filing and may be dismissed if good cause is not established.

Supporting documentation must include a signed waiver of liability (WoL) as required by the Centers for Medicare and Medicaid Services (CMS), the Remittance Advice and medical records.

Claim Appeals can also be mailed to:

Doctors HealthCare Plans, Inc.
Attn: Grievances & Appeals Unit
2020 Ponce de Leon Blvd., PH 1
Coral Gables, FL 33134


CLAIM INFORMATION

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MEMBER INFORMATION

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PROVIDER INFORMATION

REASON FOR REQUESTING REVIEW

REQUIRED DOCUMENTATION

Click or drag a file to this area to upload.
The file formats you can upload are .tiff, .jpg, .png, .doc, and .pdf. If attachment is over 10MB, please split the file to conform to size limit.
Click or drag a file to this area to upload.
The file formats you can upload are .tiff, .jpg, .png, .doc, and .pdf. If attachment is over 10MB, please split the file to conform to size limit.
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Last Updated: 03/22/2021
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