Timeframes for filing & resolving complaints

Timeframes for filing a grievance or appeal:

  • vary by line of business (i.e., CareAdvantage Cal MediConnect, Medi-Cal, Healthy Kids HMO, HealthWorx HMO and ACE)
  • are regulated by CMS and the State

CareAdvantage Cal MediConnect

Timeframe for filing

from date of denial, service, incident or bill

  • Appeal: 60 days
  • Grievance: 180 days

Timeframe for processing

TypeAppeals processingGrievance processing
Part C - Standard30 calendar days30 calendar days
Part C - Expedited72 hours24 hours
Part D - Standard7 calendar days30 calendar days
Part D - Expedited72 hours24 hours

Other lines of business

Timeframe for filing

from date of denial, service, incident or bill

Type of complaintMedi-CalOther lines of business
Appeal60 days180 days
GrievanceNo time limit180 days

Timeframe for processing

TypeGrievance and appeals processing
Standard30 calendar days
Expedited72 hours

If you have questions about the HPSM's Grievance and Appeals process, please contact HPSM Provider Services at 650-616-2106.