Pay your dispute resolution fee
If you’ve submitted your dispute resolution form, you can pay your administrative fee here.
A non-refundable administrative fee of $25 is due within 10 business days from the date we get your dispute resolution form. We can’t start the dispute process until you pay the administrative fee.
Pay online or with an app
You can pay your $25 fee by credit or debit card, PayPal, or Venmo. (Venmo is for mobile use only.)
Be sure to have your “PPDR reference number.” You can find it at the top of the email that sent you to this web page.
The $25 fee is non-refundable, but will be subtracted from the amount you owe if the dispute is decided in your favor.
Pay with a cashier’s check or money order
You can pay your $25 fee with a cashier’s check or money order, but we must receive it within 10 days of when you submit your dispute resolution form.
Be sure to write your “PPDR reference number” on your check or money order. You can find it at the top of the email that sent you to this web page.
If you don’t have your PPDR reference number: Include the National Provider Identifier (NPI) of the provider whose bill you’re disputing and the patient’s name. You can find the provider’s NPI on the good faith estimate you got from your provider.
We can’t process your dispute if you don’t include the PPDR reference number or NPI, and the patient’s name with payment.
Mail your cashier’s check or money order to:
C2C Innovative Solutions, Inc.
Patient-Provider Dispute Resolution
P.O. Box 45105
Jacksonville, FL 32232-5105
Personal checks or cash won’t be accepted.
Learn more about your protections from surprise bills.
Contact the No Surprises Help Desk at 1-800-985-3059