MedicaidAdministrativeMedium impact
23-753m Reminder About Timely Response to Enrollee Appeals and Grievances
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health has updated their policy reminding providers about strict timeframes for responding to enrollee appeals and grievances. Providers must forward appeals within 1 calendar day, respond to routine appeals within 5 working days, and expedited appeals same day, or face fines and penalties.
Action Required
Immediately: All staff must forward any enrollee appeals or grievances to Health Net Medi-Cal A&G Department within 1 calendar day of receipt. Billing and front desk staff must respond to routine appeals within 5 working days and expedited appeals same day with written response, denial reasons, and complete medical records. Use fax 877-831-6019 or mail to Member A&G, P.O. Box 10348, Van Nuys, CA 91410. Failure to meet timeframes may result in fines and penalties under Provider Participation Agreement violations.