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Submit a Dispute Form

Use the form below to submit a problem or dispute description. Alternately, you may download a dispute form and mail to SCFHP. Multiple “Like” Claims can be submitted for the same provider and dispute but different members and dates of service. To submit multiple "like" claims, fill out a Provider Dispute Form (For Use with Multiple “Like” Claims) and upload the completed PDF as an attachment in the upload section of this formSCFHP will investigate your dispute and issue a written notice of a proposed resolution within the following days from the date the dispute description is recieved:

  • 45 working days for Medi-Cal and Healthy Kids HMO providers
  • 30 days for Cal MediConnect (CMC) non-contracted providers
  • 60 days for CMC Contracted providers.
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