MedicaidAdministrativeMedium impact
21-127 How to File Appeals and Grievances for Pharmacy Issues
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Effective January 1, 2022, Medi-Cal pharmacy benefits transitioned to Medi-Cal Rx, changing where appeals and grievances must be filed. Appeals for pharmacy prior authorizations now go to California Department of Social Services State Fair Hearing process instead of the health plan.
Action Required
Immediately: Billing team must redirect all Medi-Cal pharmacy-related appeals and grievances received after January 1, 2022 to the appropriate new contacts. For member appeals, redirect to California Department of Social Services State Fair Hearing at 800-743-8525. For member complaints/grievances, redirect to Medi-Cal Rx Customer Service at 800-977-2273. For provider PA appeals, submit through Medi-Cal Rx website or mail to Medi-Cal CSC Provider Claims Appeals Unit, P.O. Box 610, Rancho Cordova, CA 95741-0610. Update staff training on new appeal processes to avoid delays in member care.