Provider Grievance Process

We understand the need for our provider partners to voice their concerns in a formal manner and receive a written response on the outcome.

Grievance Type
Time Limit
for Filing
Documentation to
Submit
How to Submit /
Who to Contact

Pre-service Appeals (All Auths)

Member Billing Issues

Member/Member Representative or Provider on behalf of Member
Same as below for each grievance type
Same as below for each grievance type
CenCal Health                   Member Services Department
4050 Calle Real
Santa Barbara, CA 93110
1-877-814-1861 
 Treatment Authorization Request (TAR) High Tech Imaging Requests Within 90 calendar days from the date of the original decision
  • Copy of original TAR and denial notification
  • Letter stating why denial or modification should be overturned
  • Documentation to support overturning the original denial or modification

CenCal Health
Health Services Department
4050 Calle Real
Santa Barbara, CA 93110
(805) 562-1820
(805) 562-1019 (Medical Director)
Medical Request Form (MRF) Within 60 calendar days from the date of the original decision
  • Copy of original or modified MRF
  • Letter stating why denial or modification should be overturned
  • Documentation to support overturning the original denial or modification
  • A new completed MRF

CenCal Health
Pharmacy Services Department 4050 Calle Real
Santa Barbara, CA 93110
(805) 562-1639
Claims Dispute
Within 365 days of the date of the EOB on which the claim first appeared (non Medi-Cal programs) Within 6 months of the date of the EOB on which the claim first appeared (Medi-Cal programs)
  • Provider name & billing number
  • Member name & ID#
  • Date of Service (DOS)
  • Claim Control Number (CCN)
  • Clear identification of disputed item
  • Clear explanation of the basis for disputing payment amount, request for additional information, denial or adjustment
Submit the Claims Dispute/Appeal Form


CenCal Health
Adjudication Department         4050 Calle Real
Santa Barbara, CA 93110
(805) 562-1083