The Claims Department will accept correspondence in the form of a Claims Payment Dispute Form. This form contains all of the information that is required to process your request. Please complete the form in its entirety and mail or submit the form securely through the MFC Claims Portal, https://mfcmdprovider.healthtrioconnect.com/.
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 EOP
- 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 can use the Claims Payment Dispute Form for all payment disputes. Providers have 90 business days from date of the denial to submit disputes.
Send this form and all supporting documents to:
MedStar Family Choice
PO BOX 211702
EAGAN MN 55121
ATTN: Payment Disputes
Providers who are enrolled in the MFC Claims Portal, https://mfcmdprovider.healthtrioconnect.com/, may submit this form and all supporting documents in the secure message feature. If you are not enrolled, please see our Provider Resources page for directions on how to enroll.
Information current as of: