CommercialAdministrativeMedium impact
23-751m Reminder About Timely Response to Enrollee Appeals and Grievances
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net updated timeframes for responding to patient appeals and grievances. Providers must forward appeals to Health Net within 1 calendar day and respond to information requests within 5 days for commercial plans or 5 working days for Medi-Cal.
Action Required
Immediately: Establish workflow to forward patient appeals/grievances to Health Net A&G Department within 1 calendar day of receipt via fax (877-831-6019) or mail (P.O. Box 10348, Van Nuys, CA 91410). Staff must respond to Provider Information Request (PIR) forms within 5 calendar days (commercial) or 5 working days (Medi-Cal) with written response and medical records. Failure to respond timely may result in fines and penalties under Provider Participation Agreement.