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Information Last Updated: 10/1/2018
1. Submission Guidelines for Non-Contracted Provider Appeals
For an appeal, the non-contracted provider MUST sign and submit a Waiver of Liability (WOL) Statement before Brand New Day can begin processing the appeal. A signed WOL is required for appeals.
2. Address for Submitting a Non-Contracted Provider Appeal
- Non-contracted providers must mail a written request to Brand New Day
- Dispute and Appeals Unit:
Brand New Day
ATTN: Provider Dispute Resolution
P.O. Box 93122
Long Beach, CA 90809 - Non-Contracted Provider Second Level Independent Review Entity Process Appeal/Reconsideration
If Brand New Day upholds the initial claim decision, Medicare requires that Brand New Day send all cases where we have not changed our decision to an independent review entity. MAXIMUS Federal Services, Inc. will contact the non-contracted provider to advise where to send any additional information and about other rights that the non-contracted provider may have.
Reference:
P.O. Box 93122 Long Beach, CA 90809
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