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What is a Grievance?
A member's expressed dissatisfaction to the Behavioral Health Plan (BHP) or any provider about any matter having to do with the provision of Medi-Cal Specialty Mental Health Services; or, through the Drug Medi-Cal Organized Delivery System.
The expressed dissatisfaction is defined as a grievance, whether or not it is submitted in writing, whether or not the member states that they wish to file a grievance, even if the member explicitly states they do not want to file a grievance and whether or not the member uses the term "Grievance."
What is an Appeal?
An appeal is a formal process that a Medi-Cal member can participate in to challenge or request a review of a Notice of Adverse Benefit Determination (NOABD) they received.
To initiate a Grievance or to file an Appeal:
- To File by Phone: Contact the Quality Management Services (QMS) Managed Care Support Team between 8:00 AM and 5:00 PM, Monday through Friday by calling (714) 834-5601 or (866)308-3074. Or, if you have trouble hearing or speaking, please call (866) 308-3073.
- To File Electronically: Email the BHPGrievanceNOABD@ochca.com
- To File by Fax: Dial 714-480-0755
- To File by Mail: Print and fill out a Grievance or Appeal Form and mail to:
QMS Managed Care Support Team
400 W. Civic Center Dr. 4th Floor
Santa Ana, CA. 92701
- To File in Person: You may access the Grievance or Appeal Form from any BHP program and file directly with a program representative.
Or, you may file in person with a QMS Managed Care Support Team representative at:
QMS Managed Care Support Team
400 W. Civic Center Dr. 4th Floor
Santa Ana, CA. 92701
As an alternative for the Behavioral Health Plan and Inpatient grievances, you may call HCA's Patients' Rights Advocacy Services at 800-668-4240 or 714-276-8145. Visit their webpage for brochures, posters, and more information.
Grievance or Appeal Form
Grievance or Appeal Process Posters - Specialty Mental Health Services - Legal Size Print
Grievance or Appeal Process Posters - Specialty Mental Health Services - Large Size Print
Grievance or Appeal Process Posters - Drug Medi-Cal Organized Delivery System - Legal Size Print