Timeframes for filing & resolving complaints
Timeframes for filing a grievance or appeal:
- vary by line of business (i.e., CareAdvantage, Medi-Cal, 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
| Type | Appeals processing | Grievance processing |
| Part C - Standard | 30 calendar days | 30 calendar days |
| Part C - Expedited | 72 hours | 24 hours |
| Part D - Standard | 7 calendar days | 30 calendar days |
| Part D - Expedited | 72 hours | 24 hours |
Other lines of business
Timeframe for filing
from date of denial, service, incident or bill
| Type of complaint | Medi-Cal | Other lines of business |
| Appeal | 60 days | 180 days |
| Grievance | No time limit | 180 days |
Timeframe for processing
| Type | Grievance and appeals processing |
| Standard | 30 calendar days |
| Expedited | 72 hours |
If you have questions about the HPSM's Grievance and Appeals process, please contact HPSM Provider Services at 650-616-2106.
