Plan Resources

Submit a Healthcare Claim or Bill

To submit a Healthcare Claim or Bill, please mail the Claim or Bill to:

Write: Champion Health Plan
Attn: Claims Department
PO Box 15337
Long Beach, CA 90815-9995

Call: 1-800-885-8000 | TTY 711

Submit a Part D Prescription Drug Claim or Bill

Download Form: Click Here

To submit a Healthcare Claim or Bill, please complete the form and submit the form and receipt(s) to:

MedImpact Healthcare Systems, Inc.
PO Box 509108
San Diego, CA 92150-9108

Fax: 858-549-1569
E-mail: Claims@Medimpact.com

Grievances and Appeals

Champion Health Plan is interested in hearing from you about what is not working, as well as, how you would like it to. We are interested in complaints you may have about services you received, the way you were treated, the care you received (or didn’t receive in a timely manner), if you were charged incorrectly, or any other complaint you may have. We want to correct any inappropriate behavior, processes, or payments. You will not be “in trouble” or mistreated by us or your doctors if you complain. We’ll make sure of it. Your calls help us improve.

Filing a Grievance or Complaint

The first step is to call and tell them your complaint. The representative who answers your call will write it down for you and will send it immediately to the Grievance Department.

If you do not wish to call, you can put your complaint in writing and send it to us by fax or letter. Write a description regarding what caused you to be unhappy or mad. In your description include dates, names, and tell us all about the problem. If you put your complaint in writing, we will respond to your complaint in writing. We will research the matter, and we will respond to you within 30 days.

Appeals and Grievance Department

Phone 1-800-885-8000|TTY: 711
Fax (949) 227-3791

Contact Hours of Operation
April 1 – September 30
Monday – Friday, 8 a.m. – 8 p.m.

October 1 – March 31
7 days a week, 8 a.m. – 8 p.m.

Email
Grievance.Appeals@championpayer.com

Mail Address
Attn: Appeals and Grievance Department

P.O. Box 15337
Long Beach, CA 90815-9995

Whether you call or write, you should contact us as soon as possible after the incident. Complaints should be made within 60 calendar days of the day you had the problem.

We will look into your complaint and give you an answer. We must respond whether we agree with the complaint or not.

If possible, we will answer you right away. If you call us with a complaint, we may be able to give you an answer at the time you call.
Most complaints are answered in 30 calendar days. If your health condition requires us to answer more quickly, we will do that. If we need more information and the delay is in (44 calendar days total) to answer your complaint.
If you are making a complaint because we denied your request for a “fast coverage decision” or a “fast appeal,” we will automatically give you a “fast” complaint. If you have a “fast” complaint, it means we will give you an answer within 24 hours.

If we are not helping with your complaint, you can submit a complaint about directly to Medicare. Medicare takes your complaints seriously and will use the information to help improve the quality of the Medicare program.

If you have any other feedback or concerns, or if you feel the plan is not addressing your issue, please call1-800-MEDICARE (1-800-633-4227), available 24 hours, 7 days a week including some federal holidays. TTY/TDD users can call 1-877-486-2048.

To submit a complaint to Medicare, go to:
https://www.medicare.gov/MedicareComplaintForm/home.aspx

Appointment of Representative

Appoint Representation

Community Based Resources

Click on the links below for useful information and services in your community.

National Kidney Foundation (NKF)
Offers education, information, and chapters in most states that you can join. The NKF has also developed clinical practice guidelines for the treatment of kidney disease and kidney failure.

National Kidney Foundation of Southern California
Learn about kidney disease. Ways to prevent and treat disease, patient programs, links, support groups, organ donation FAQs, and how to help.

Fresno Nephrology Kidney Foundation
Our support groups allow you to get in touch with others affected by kidney disease, giving you a chance to share tips, learn from others’ experiences and provide mutual support.

American Kidney Fund-Kitchen
Find Kidney friendly recipes and more.

Life Options Rehabilitation Program
Dedicated to helping people live long and live well with kidney disease. Offers encouragement and free educational materials, with a special emphasis on staying active through exercise and employment.

American Kidney Fund
Provides educational programs, clinical research and community service projects.

American Association of Kidney Patients (AAKP)
AAKP is the voluntary, patient organization, which for more than 40 years, has been dedicated to improving the lives of fellow kidney patients and their families by helping them deal with the physical, emotional, and social impact of kidney disease. The programs offered by AAKP, inform and inspire patients and their families to better understand their condition, adjust more readily to their circumstances and assume more normal, productive lives in their communities.

Alport Syndrome Foundation®
The Alport Syndrome Foundation is a non-profit organization founded in 2007 by a group of families affected by the disease and guided by a medical advisory committee of renowned nephrologists.

Renal Support Network (RSN)
A nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by chronic kidney disease (CKD).

National Kidney Registry
The mission of the National Kidney Registry (NKR) “is to save and improve the lives of people facing kidney failure by increasing the quality, speed, and number of living donor transplants in the world.”

The Nephron Information Center
Allows patient, professionals, and the public access to the vast kidney disease resources on the Web. Links. Animated GIFS, preESRD education, Fadem’s Kidney Guide

How Your Kidneys Work
A thorough but friendly education on the many functions of the kidneys.

Type 2 Diabetes
Healthline provides a comprehensive overview of type 2 diabetes as a critical starting point for individuals and/or their loved ones.

The DASH Diet
Download or order the 20 page National Institutes of Health document for reducing blood pressure through diet.

Body Mass Index (BMI) Calculator
From the Centers for Disease Control (CDC).

Kidney Disease Information
Resources and fact sheets from NIDDK.

Transplant Living
Transplant resources from the United Network for Organ Sharing (UNOS), the organization that maintains the U.S. organ transplant waiting list.

Member Rights and Responsibilities

Champion Health Plan members have the right:

To be treated with fairness, respect, dignity, and consideration for privacy; including protection from release of any information that identifies them to anyone other than those having an “identified need for the information.”
To the privacy of their medical records and personal health information. To have health and medical records, as well as any other information, treated with confidentiality, regardless of the format of that information (i.e., spoken communications, written materials, electronic records, or facsimiles).
To have access to their medical records in accordance with law.
To be free from discrimination based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
To see plan providers and get covered services within a reasonable period of time. To have services accessible and available to them.
To access emergency health care services without prior authorization.
To choose providers for both primary and specialty care, from among those affiliated with Champion Health Plan and/or the participating Medical Group and to refuse care from any specific providers.
To know treatment choices and participate in decisions about their health care.
To use an advance directive (such as a living will or a power of attorney).
To choose a representative to facilitate care or treatment decisions, including withholding resuscitative services or to forgo or withdraw life-sustaining treatment, when they are unable to do so.
To receive information on available treatment options (including the option of no treatment) or alternative courses of care in a language they understand.
To make complaints and obtain a prompt resolution of issues (including complaints, grievances or appeals) relating to authorization, coverage, or payment of services.
To get information about their health care coverage and costs.
To get information about Champion Health Plan and their Medical Group and any contracted providers.
To get more information about their rights.

Champion Health Plan members have the responsibility:

To become familiar with their coverage and the rules that must be followed to get care as a member.
To give doctors and other health care providers the information they need to provide health care.
To pay any applicable copayment, deductible, co-insurance or charge for non-covered services when requested by their Champion Health Plan/Medical Group physician.
To act in a way that supports the care given to other patients and helps the smooth running of the doctor’s office, hospital, and other offices.
To let us know if they have any questions, concerns, or suggestions.

Disenrollment

Ending your membership in Champion Health Plan may be voluntary (your own choice) or involuntary (not your own choice):

Please note these important points

If Champion Health Plan ends your membership involuntarily, we will send you a notification telling you our reasons.
If you disenroll from our plan voluntarily we will send you a confirmation letter acknowledging the receipt of your request and stating the effective date of your disenrollment
You have the right to make a complaint if we end your membership in our Plan.

Voluntarily ending your membership
You can voluntarily disenroll from Champion Health Plan by submitting a written notification requesting to disenroll from our plan. Please include your name and member ID on the written letter and mail it to:

Champion Health Plan
Attn: Enrollment/Disenrollment
PO Box 15337
Long Beach, CA 90815-9995

You can also call 1-800-MEDICARE or switch to another Medicare organization. If you disenroll by calling 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week, or consult www.medicare.gov or switch to another Medicare organization, you do not need to submit written notification to Champion Health Plan. Your membership will end automatically once we receive the notification from Medicare. Once notification of the disenrollment request is received, typically your membership will end the first of the following month after the request is received.

If you leave our plan, it may take time before your membership ends and your new Medicare coverage goes into effect. During this time, you must continue to get your medical care and prescription drugs through our plan until your disenrollment goes into effect and your Champion Health Plan coverage ends.

Involuntarily ending your membership
Involuntary disenrollment means that Champion Health Plan can disenroll you from the plan if the following situations occur:

If you no longer meet the eligibility requirements to remain a member of Champion Health Plan.
If you engage in disruptive behavior, to the extent that your continued enrollment seriously impairs the ability to arrange or provide medical care for you or for others who are members of the Plan.
If you provide fraudulent information on an enrollment request
If you permit abuse of an enrollment card by letting someone else use your medical ID card. If you are disenrolled for this reason, the Centers for Medicare and Medicaid Services (CMS) may refer your case to the Inspector General for additional investigation.

If you are leaving our plan, you must continue to get your medical care through our plan until your membership ends.

For more information on ending your membership, please refer to your Evidence of Coverage (EOC) Document, Chapter 10 or click on this link to view an EOC online: Evidence of Coverage (EOC)

This page was last updated on 10/15/23. Pending CMS approval.