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-DC Provider Portal, MFCDCProvider.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
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.
Send this form and all supporting documents to:
MedStar Family Choice DC
PO Box 211702
Eagan, MN 55121
ATTN: Payment Disputes
Information current as of: