Claims Information

Claims Information

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 
Appeals Department
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
Appeals/Grievance Unit
P.O. Box 811610
Los Angeles, CA  90017

Questions about MemorialCare Select Health Plan?

Call Us at (855) 367-7747