Skip to main content

HSCSN Claims Appeals & Unusual Incidents

Complaints and Appeals

A member, provider or other representative acting on behalf of the member may submit a complaint, grievance or appeal for any coverage determination issued by HSCSN.

Read about the complaint, grievance and appeal processes [PDF - 100 KB].

Send a letter of appeal and all documentation to HSCSN. Please be sure that you explain why the rejection or payment should be reversed. Include any documentation to support your request. If a claim was incorrectly sent to DC Medicaid and now we are denying it for late filing, please include a copy of the letter from DC Medicaid.

Mail your letter and all documentation to:

HSCSN Claims
Attention: Provider Services
P.O. Box 29055
Washington, DC 20017

If you have a claims or appeal question, contact Provider Services at 202-495-7526.

Unusual Incident Report

Report any of the following safety issues to HSCSN:

  • Unusual Occurrence/Incident – an incident that does not meet safety standards or the standard of care or routine operations of a provider that deviate from regular operations or established procedures.
  • Sentinel Event – an unexpected occurrence involving death or serious physical or psychological injury, or risk thereof.
  • Serious Reportable Event/Never Event – an error in medical care that is clearly identifiable, preventable, and serious in their consequences for patients, includes surgical events, product or device events, patient protection events, care management events, environmental events and criminal events.

All reports should be reported on the HSCSN Unusual Incident Report Form [PDF - 824 KB] and sent to Kathy Goin, Risk Manager, at Reports may also be faxed to (202) 635-5591.