Resources
Medi-Cal, OneCare (HMO SNP) and OneCare Connect maintains a provider complaint process to review and resolve provider disputes for claims payment, as well as utilization management decisions and other non-payment related issues.
There are two levels in the provider complaint process:
The provider complaint process contains different procedures, depending upon whether the provider filing the complaint is a Medi-Cal, OneCare (HMO SNP) or OneCare Connect contracted provider or non-contracted provider.
To review the complete provider complaint process, see section R1 of the CalOptima Health Provider Manual.
Provider Dispute Resolution Request Form Use this form to submit a Level 1 complaint.
Provider Complaint Resolution Form — Level 2 Use this form to submit a Level 2 complaint.
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