Claims & Provider Dispute Submission
Non-contracted providers have the right to submit claims and disputes when they do not agree with a payment decision.
Submission and processing timelines follow Centers for Medicare & Medicaid Services (CMS) guidelines.
Claims submission
Submit claims electronically or by mail. Electronic submission is preferred and reduces processing time.
Claims must be submitted within the applicable filing deadline.
Electronic submission (Preferred)
Submit claims electronically through Availity using the following payer information:
CLEARINGHOUSE
Availity
PAYER ID
CARM0
Paper claims by mail
Mail completed CMS-1500 or UB-04 claim forms to:
CareMore Health
Attn: Claims Department
P.O. Box 366
Artesia, CA 90702
Include a copy of your remittance advice if resubmitting a previously denied claim.
Provider disputes
A provider dispute is a written communication from a non-contracted provider challenging a claim payment decision, denial, or other determination. All disputes must be submitted in writing.
Claims disputes from contracted providers should be made in accordance with the contracted provider’s contract with CareMore. Appeals must be sent directly to member’s Health Plan.
How to submit a dispute
Complete the Provider Dispute Resolution Request form and mail it to CareMore Health. Disputes submitted via fax or email will not be accepted.
Provider Dispute Resolution Request Form
Mail Provider Dispute Resolution Request forms to:
CareMore Health
Attn: Claims Department
P.O. Box 366
Artesia, CA 90702
Disputes must be submitted in writing within 120 calendar days from the date on the remittance advice.
Timelines and required information
Dispute timelines
The following timelines apply to provider dispute submissions and CareMore Health’s response obligations.
Submit your written dispute
120
calendar days
from the date on the remittance advice
CareMore Health response
60
calendar days
from receipt of your dispute or amended dispute
Required information
To ensure timely processing, include all of the following with your dispute submission:
- Provider name, NPI, and Tax ID number
- Member name, date of birth, and CareMore Health member ID
- Date(s) of service and claim number(s) being disputed
- Copy of the Explanation of Benefits (EOB) or remittance advice
- Written statement explaining the basis for the dispute
- Supporting clinical documentation (if applicable)
- Contact name and return mailing address for correspondence
Contact us
Our provider relations and customer service teams are here to help with claims, disputes, and general questions.
Provider Customer Service
General Inquiries
888-291-1358
Monday to Friday
5:00 am to 5:00 pm PT
Provider Portal
Self-service
Check eligibility, view claims status, and manage authorizations online.