Resources to help you with claims, prior authorizations, prescription drugs and more

We’ve gathered everything you’ll need to interact with Scripps Health Plan. If you can't find something you're looking for, please contact us at 844-337-3700.


Forms



Documents



Provider dispute resolution

While we hope that our providers will never have a need to report a dispute, Scripps Health Plan does offer a mechanism for submitting dispute information for review. Examples of provider disputes include:


  • Instances where a provider contends that the amount paid for a covered service is less than the contracted rate, including those claims denied for no authorization
  • Instances where there is a disagreement between a provider and Scripps Health Plan’s coding and payment policies


For these types of disputes, the Provider Dispute Resolution Form (PDF, 160 KB) should be completed and faxed or mailed using the contact information on the form. Please call Scripps Health Plan customer service for any questions related to the provider dispute process.


This process should not be used related to medical necessity determinations or circumstances where no initial determination was made by Scripps Health Plan. For more guidance, refer to the Provider Operations Manual. (PDF, 1.4 MB)