Claims Payment Dispute

The Claims Department will accept correspondence in the form of a Claims Payment Dispute form. MedStar Family Choice has developed a new form for your convenience. This form contains all of the information that is required to process your request. Please complete the form in its entirety and mail or email the form to the address listed on the Claims Payment Dispute form.

A claims payment dispute may be submitted for multiple reason(s), including:

  • Contractual payment issues
  • Disagreements over reduced or zero paid claims
  • Other health insurance denial issues
  • Submit another carrier’s EOB
  • Retro-eligibility issues
  • Paid to wrong provider
  • In/Out Network issue
  • Claim denied for lack of authorization but you have proof of prior authorization

Providers must use the Claims Payment Dispute form for all payment disputes or your request will not be processed. Providers have 90 business days from date of the denial.

Send this form and all supporting documents to:

Secure Email: [email protected] or
Address: MedStar Family Choice
PO Box 2189 Milwaukee, WI 53201
ATTN: Payment Disputes
Phone: 800-261-3371

Information current as of: 09/02/20