SCAN Health Plan Timely Filing Limit and Provider Appeal Rules

What is SCAN's timely filing limit? It is the deadline for SCAN Health Plan to receive an original claim: one year from the date of service or discharge under SCAN's 2026 California Provider Operations Manual, unless a provider's contract states a different period.

Undeny's Take

SCAN is a Medicare Advantage plan with generous filing time and stingy post-decision time. A year to file the claim lulls offices into slow follow-up, but a contracted provider then has only 60 calendar days from SCAN's last written determination to dispute it, a fraction of the 365-day windows California billers know from commercial HMOs. Work SCAN remits weekly, not monthly. Second, figure out who actually adjudicated the claim. SCAN delegates claims processing to some medical groups, and its manual says it may reject or deny claims that belong to a delegate and forward them on, so the remittance you are reading may not be SCAN's final word. Third, when SCAN's own pages disagree on a deadline, file by the shorter one.

Contracted, Non-Contracted or Delegated: Three SCAN Tracks

SCAN's 2026 California Provider Operations Manual (POM) and its "How to Submit Disputes & Appeals" page split providers into three tracks:

• Contracted providers: "Payment disputes and appeals processes for contracted providers are governed by the terms of the contract between the provider and SCAN and the information below." Where the contract is silent, the manual tells you to follow the non-contracted process.
• Non-contracted providers: federal Medicare Advantage rules apply. Denials (zero payment) are appealed with a Waiver of Liability; payment amount disagreements go through a two-level Payment Dispute Resolution (PDR).
• Delegated claims: when a medical group or IPA is delegated to pay claims for SCAN, the first-level payment dispute goes to that group, and SCAN's delegate dispute form is used only "after the provider has exhausted all attempts with the delegate."

SCAN publishes these processing times on its disputes page: 30 calendar days for non-contracted fee schedule disputes, billing errors and minor corrections, 45 calendar days for Medicaid, and 60 calendar days for contracted providers.

The 60-Day Contracted Provider Dispute

A SCAN Health Plan provider dispute from a contracted provider has a short fuse. For disputes about claim determinations SCAN made, the manual says "the provider must submit a provider dispute of a decision to SCAN within sixty (60) calendar days of the last written determination." Fax is SCAN's preferred channel, at 562-997-1835, using the Provider Dispute Resolution (PDR) Request form with the contracted dispute type checked (underpayment, authorization denial, retro authorization request, billing determination or overpayment request). If you cannot fax, mail it to SCAN Health Plan, Attn: SCAN Claims Provider Disputes, P.O. Box 21543, Eagan, MN 55121.

Your dispute should explain why the determination was wrong, identify the evidence in the claim record that supports you, and attach anything else SCAN needs to evaluate it. SCAN responds in writing within 60 calendar days unless your contract says otherwise. Only after that step can you use the further dispute process in your contract.

Non-Contracted Denials: Waiver of Liability Appeals

1. Confirm the claim was denied with zero payment; an underpayment goes through the payment dispute process instead.
2. Count 60 calendar days from your receipt of the Remittance Advice; that is the shortest deadline SCAN publishes.
3. Complete and sign the SCAN Waiver of Liability (WOL) Statement, agreeing not to collect from the member for the denied services.
4. Gather the Remittance Advice, a copy of the claim, the medical records and any other documentation that supports payment.
5. Fax the WOL and attachments to SCAN at 562-989-0958, the preferred method, or mail them to SCAN Health Plan, Attn: SCAN Non-Contracted Provider Appeals, P.O. Box 22616, Long Beach, CA 90801-9826.
6. Allow 60 days for a decision, counted from the day SCAN receives the WOL.
7. If SCAN upholds the denial, expect the case to go automatically to MAXIMUS for the next level of review.

A SCAN Health Plan appeal without the waiver is not a valid appeal. CMS guidance gives non-contract providers 65 calendar days from the remittance notification date, and SCAN's disputes page also says 65 days. SCAN's 2026 manual and its Claims/EDI page say 60. Without a WOL there is no appeal: SCAN's manual says a request without a timely WOL "will be sent to MAXIMUS for dismissal."

Underpaid, Not Denied: The Two-Level PDR

SCAN Payment Dispute Resolution (PDR) for non-contracted providers is for disputing the amount paid for a covered service, for example when you believe it is less than Original Medicare would have paid. It "cannot be used to challenge payment denials that result in zero payment."

Level	Deadline	Where it goes	Decision time
1st level PDR	120 calendar days from receipt of the RA	The payer that issued the RA (SCAN, or the medical group if delegated for claims)	30 calendar days
2nd level PDR	180 calendar days from receipt of the upheld 1st level decision	SCAN only (never delegated), by fax or to Attention: Claims-2nd Level Appeal at the Eagan, MN box	60 calendar days

Underpayments often show up as contractual adjustments such as CO-45; for a non-contracted provider, the question is whether the allowed amount matches what Original Medicare would pay.

Reopening Requests for Clerical Errors

For a SCAN-processed claim with a clerical error or omission, file a SCAN reopening request on the Medicare Dispute Reopening Request form instead of an appeal. SCAN's form says it "must be submitted within one year from the date of receipt of the Remittance Advice (RA)," that requests after one year are only accepted if an overpayment is found, and that SCAN completes a reopening within 60 days. Fax it to 562-997-1835 or mail it to the Eagan, MN dispute box.

Claims Paid by a SCAN Medical Group

SCAN's manual says it "may reject or deny claims which are received by SCAN for which a delegated entity is responsible for claims processing" and forwards them to the delegate. The correct billing address is on the back of the member's SCAN ID card or in the member's eligibility record on the SCAN Provider Portal. For delegate-processed claims, status questions and first-level disputes go to the delegate's own portal or call center; bring SCAN in with the Provider Delegate Claim Dispute Resolution Form only after the delegate's process is exhausted, and include the delegate's denial letters, remittance advice and authorizations.

Rejected, Late and Corrected Claims

• Rejected is not denied. SCAN may reject claims that are not clean, and "Rejected claims do not have Appeal rights." Correct and resubmit; a resubmission after one year from the date of service or discharge is denied as untimely. See CO-16 for common missing-data causes.
• Late claims rarely survive. "Untimely claims are not eligible for dispute or appeal except in rare circumstances where the delay was caused through no fault of the provider." Our CO-29 guide covers what counts as proof.
• Requested records have a clock. When SCAN asks for medical records, invoices or an itemized bill, send them within 45 days for reconsideration of the claim.
• Electronic claims use payer ID SCAN1, and SCAN asks providers to check claim status in the portal before sending requests for information.

Where SCAN's Own Pages Disagree

As of October 2026, SCAN's sources conflict in two places. The non-contracted appeal window is 65 calendar days on the disputes page but 60 in the 2026 manual and on the Claims/EDI page. The non-contracted appeal mailing address is P.O. Box 22616 on the disputes page but PO Box 22644 on the Claims/EDI page. File within 60 days and use the fax number on the disputes page, which avoids both conflicts.

Frequently Asked Questions

What is the SCAN Health Plan timely filing limit?

SCAN's 2026 California Provider Operations Manual requires claims within one year of the date of service or discharge, unless your contract states otherwise. Claims received after one year are denied as untimely and generally are not eligible for dispute or appeal.

How long does a contracted provider have to dispute a SCAN claim?

Sixty calendar days from SCAN's last written determination, unless your contract sets other terms. SCAN prefers the dispute by fax with its PDR Request form and responds in writing within 60 calendar days.

How does a non-contracted provider appeal a SCAN denial?

Send a signed Waiver of Liability with the remittance, the claim and supporting records within 60 calendar days of receiving the remittance to be safe. SCAN decides within 60 days of receiving the waiver, and upheld denials go automatically to MAXIMUS.

What is the difference between a SCAN appeal and a payment dispute?

An appeal challenges a denial that resulted in zero payment and requires a Waiver of Liability from non-contracted providers. A payment dispute challenges the amount paid on a covered service and has two levels, due within 120 days and then 180 days.

What if a SCAN medical group processed my claim?

Start with the medical group. First-level payment disputes are delegated to medical groups that are delegated for claims, and SCAN's delegate dispute form is only for after you have exhausted the group's process. The billing address is on the member ID card or the portal eligibility record.

Can I fix a coding error without appealing?

Yes. For SCAN-processed claims, the Medicare Dispute Reopening Request corrects a clerical error or omission without a formal appeal. It must be submitted within one year of receiving the Remittance Advice, and SCAN completes it within 60 days.

Informational only, not legal, medical, or billing advice. Verify against SCAN's current Provider Operations Manual, its disputes page and your contract before filing.

Draft the SCAN Appeal Letter

Undeny drafts the appeal narrative from your denial code so the WOL packet or PDR form goes out well inside SCAN's window. Generate an appeal · Start a SCAN appeal · Join the waitlist