MedicaidAdministrativeHigh impact
21-126 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, all Medi-Cal pharmacy appeals and grievances must be filed directly with state agencies instead of Health Net. Providers must use new contact information and processes for prior authorization appeals, claim appeals, and member grievances related to Medi-Cal Rx pharmacy services.
Action Required
Immediately: Update billing team procedures to redirect all Medi-Cal pharmacy appeals to the correct agencies. For PA appeals, submit to Medi-Cal CSC Provider Claims Appeals Unit at P.O. Box 610, Rancho Cordova, CA 95741-0610 or via Medi-Cal Rx website. For member appeals, direct to California Department of Social Services at 800-743-8525. For grievances, direct to Medi-Cal Rx Customer Service at 800-977-2273. Update staff training materials and create quick reference guide with new contact information. Do not submit these appeals to Health Net as they will be redirected, causing delays.