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

Claim Disputes for Participating Providers

 

Participating providers may submit a Claim Dispute within one hundred twenty (120) calendar days from the date of the corresponding Remittance Advice. Claim Disputes submitted past one hundred twenty (120) days from the date of the corresponding Remittance Advice will be considered a late filing and shall be rejected.

Supporting documentation must include the Remittance Advice and medical records; additional evidence may be required in specific cases.  Incomplete submissions will not be accepted.

Please allow sixty (60) days for processing. 

For additional information, please contact your Provider Relations Account Executive at (305) 422-9300 Option 2.


CLAIM INFORMATION

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Select 1 for first time submission and 2 for re-submission

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.
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Last Updated: 03/22/2021
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