The MemorialCare Link is the preferred method for contracted providers to check claim status. If you are a registered provider, simply click here.
For general claims questions, please click on the document below for more information.
If your questions are not answered above and you are still in need of assistance contact our Claims Inquiry Department at (855) 367-7747 by pressing 1 and a Claims Inquiry Representative will assist you.
Effective October 18, 2019 please use the Provider Dispute Resolution Form below and mail the form to:
Mailing Address:MemorialCare Select Health Plan Attn: Appeals and Disputes PO BOX 20900 Fountain Valley, CA 92728
Medicare Non-Contracted Providers > Important Information About Your Appeals Rights
MemorialCare Select Health Plan contracts with Health Plans who contract with CMS as a Medicare Advantage organization. In accordance with CMS regulations, providers who are not contracted with a Medicare Advantage organization may file a standard appeal for a claim that has been denied, in whole or in part, but only if they submit a completed Waiver of Liability Statement (pdf). If you complete a Waiver of Liability Statement, you waive the right to collect payment from the member, with the exception of any applicable cost sharing, regardless of the determination made on the appeal.
The Waiver of Liability Form can be found below. Please include documentation such as a copy of the original claim, remittance notification showing the denial, and any clinical records and other documentation that supports your argument for reimbursement.
If you appeal and the health plan upholds the denial, in whole or in part, you will have additional appeal rights available to you including, but not limited to, reconsideration by a CMS contracted independent review entity.
To appeal, mail your request and completed Waiver of Liability Statement within 60 calendar days after the date of this notice to the corresponding Health Plan:Health Net Medicare
PO Box 10406
Van Nuys, CA 91410-0406 Blue Shield
Final Provider Appeal and Resolution Office
P.O. Box 629011
El Dorado Hills, CA 95762-9011 LA Care Health Plan
P.O. Box 811610
Los Angeles, CA 90017
Federal False Claims Act (FCA)
MemorialCare Select Health Plan complies with all applicable federal and state laws including the Federal False Claims Act (FCA). The federal False Claims Act (31 USC § 3729-33 is a federal law that makes it a crime for any person or organization to knowingly make a false record or file a false claim to any program funded directly, in whole or in part, by the federal government.
Examples of Federal False Claims Act Violations:
- Submitting a false claim for payment,
- Making or using a false record or statement to obtain payment for a false claim,
- Conspiring to make a false claim or get one paid, or
- Making or using a false record to avoid payments owed to the U.S. Government.
Penalties for violating the federal False Claims Act are significant. Financial penalties for submitting a false claim can total as much as three times the amount of the claims, plus fines of $5,500 - $11,000 per claim.
The False Claims Act also protects individuals who report alleged fraud in good faith from retaliation. MemorialCare Select Health Plan will investigate allegations of fraud, waste and abuse – and reports of non-compliance on any level.
You can report your concern anonymously by calling or emailing the Compliance & Ethics Hotline.
Compliance & Ethics Hotline
Available 24/7, 365 days of the year
Dial toll-free: 888-933-9044 OR Online: memorialcare.ethicspoint.com