MedicaidAdministrativeMedium impact
26-601 Member Appeals and Grievances Process Overview and Reminders
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health has updated their member appeals and grievances process, emphasizing that providers must respond promptly and completely to requests for medical records during appeal investigations. The policy clarifies that appeals should be directed to Health Net for resolution and outlines specific requirements for timely submission of complete medical records.
Action Required
Immediately: Download and make available member appeal and grievance forms from Health Net website. Post appeal instructions in patient-accessible locations. Ensure signed consent forms are obtained before submitting appeals on behalf of patients. When medical records are requested for appeals, respond by the due date listed with complete, accurate, legible records at no cost. If no records exist for requested timeframe, notify CalViva Health promptly in response.