Claim Disputes for Participating Providers

Participating providers may submit a Claim Dispute for denied, underpaid, or incorrectly processed claims.

Participating providers may submit a 1^st Level Claim Dispute within one hundred and twenty (120) calendar days from the date of the corresponding Remittance Advice. 1^st Level Claim Disputes are reviewed by personnel, appropriate to the claim type and issue, different from the personnel that made the initial determination. Claim Disputes submitted past one hundred and twenty (120) days from the date of the corresponding Remittance Advice are considered a late filing and are dismissed.

If the provider is not satisfied with the outcome of the 1^st Level Claim Dispute, the provider may file a 2^nd Level dispute within thirty (30) calendar days from the date of the corresponding Remittance Advice. 2^nd Level Claim Disputes are reviewed by personnel appropriate to the claim type and issue, different from the personnel that made the determination on the 1^st Level Claim Dispute. Claim Disputes submitted past thirty (30) days from the date of the corresponding Remittance Advice are considered a late filing and are dismissed.

Claim Dispute can be submitted online via: https://www.doctorshcp.com/claim-dispute-form-par/ (scroll down for online submission) or mail to Doctors HealthCare Plans, Inc. Provider Inquiry/Claims Dispute Unit, 2020 Ponce de Leon Blvd., PH1, Coral Gables, FL 33134.

Please include:

Claim Information	Supporting Documentation
Claim ID Date of Service Dispute Level Member name Member ID Member Date of Birth Provider Name Provider Tax ID Provider Fax Provider Email Address Dispute Type Reason for dispute	Medical records Remittance Advice Invoices Itemized bill Any additional documentation or guidelines that may support the case

Claim Disputes submitted online generate a confirmation number for tracking purposes. A Claim Dispute may be Approved, Denied or Dismissed.

A Claim Dispute may be dismissed for the following reasons:

Insufficient or missing information
Late filing; i.e., Claim Dispute was filed past 120
Duplicate; Claim Dispute is a duplicate of a current case

Please allow sixty (60) calendar days from the submission date for processing of 1^st and 2^nd Level Claim Disputes. Once the Claim Dispute has been processed, a Notice of Resolution is sent. For assistance, please call your Provider Relations Account Executive at (305) 422-9300 Option 2.

Claim Disputes for Delegated Providers

Provider participating in Delegated Networks must follow the delegated entity’s dispute process as outlined in their provider agreement/manual.

CLAIM INFORMATION

Claim ID *

Date of Service *

Dispute Level

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

MEMBER INFORMATION

Member Name *

First

Last

Member ID *

Date of Birth *

PROVIDER INFORMATION

Provider Name *

Tax ID *

Contact Name *

Fax *

Email *

REASON FOR REQUESTING REVIEW

Dispute Type *

REQUIRED DOCUMENTATION

Remittance Advice

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The file formats you can upload are .tiff, .jpg, .png, .doc, and .pdf. If attachment is over 30MB, please split the file to conform to size limit.

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Last Updated: 06/13/2025
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