Grievances, Coverage Determination and Appeals Process

What to do if you have a problem or concern with IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan)?

  • For some types of problems, you need to use the process for coverage decisions and making appeals.
  • For other types of problems you need to use the process for making complaints.

Both of these processes have been approved by Medicare. To ensure fairness and prompt handling of your problems, each process has a set of rules, procedures, and deadlines that must be followed by us and by you.

If you are receiving Long-Term Services and Supports and you have a problem or concern:

  • If you are having a problem with your care, you can call the Cal MediConnect Ombuds Program at 1-855-501-3077 for help.
  • For In-Home Support Services (IHSS) you can utilize the State Fair Hearing process with the County Social Service Agencies to appeal your authorized IHSS hours.
  • For problems and concerns regarding eligibility determinations, assessments, and care delivered by our contracted Community Based Adult Services (CBAS) centers, Multipurpose Senior Services Program (MSSP) sites, or Nursing Facilities/Sub-Acute Care Facilities, you should follow the process outlined below:
    • Community Based Adult Services (CBAS) - 
      • You can call IEHP Member Services at 1-877-273-IEHP (4347) and ask for a Member Complaint Form. If you need help to fill out the form, IEHP Member Services can assist you. 
      • You can give the completed form to any IEHP Provider or mail it to: P.O. Box 1800, Rancho Cucamonga, CA, 91729-1800
      • You can file a grievance online. This form is for IEHP DualChoice as well as other IEHP programs.
    • Multipurpose Senior Services Program (MSSP) -
      Forward appeals to: Appeals Unit, P.O. Box 1409, San Bernardino, CA 92401

Use the links below to determine the type of problem you are having:

Help in Handling a Problem
You can contact Medicare. Here are two ways to get information directly from Medicare:

  • You can call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
  • You can visit the Medicare website: http://www.medicare.gov/
    By clicking on this link, you will be leaving the IEHP DualChoice website.

Get Help from an Independent Government Organization
We are always available to help you. But in some situations you may also want help or guidance from someone who is not connected with us. You can always contact your State Health Insurance Assistance Program (SHIP). This government program has trained counselors in every state. The program is not connected with us or with any insurance company or health plan. The counselors at this program can help you understand which process you should use to handle a problem you are having. They can also answer your questions, give you more information, and offer guidance on what to do.

The services of SHIP counselors are free. You will find phone numbers in Chapter 8 of the IEHP DualChoice Member Handbook.

Get Help and Information from DHCS

  • Call: 1-916-445-4171
  • MCI from TDD at 1-800-735-2929
  • MCI from Voice Telephone: 1-800-735-2922
  • Sprint from TDD at 1-800-877-5378
  • Sprint from Voice Telephone: 1-800-877-5379
  • Write to:
    Department of Health Care Services
    1501 Capitol Ave.
    P.O. Box 997413
    Sacramento, CA 95899-7413
  • Website: www.dhcs.ca.gov
    By clicking on this link, you will be leaving the IEHP DualChoice website.

Get Help and Information from Medi-Cal
The Cal MediConnect Ombuds Program can answer your questions and help you understand what to do to handle your problem. The Cal MediConnect Ombuds Program is not connected with us or with any insurance company or health plan. They can help you understand which process to use.

  • Call: 1-855-501-3077 (TTY 1-855-847-7914)
    Hours of Operation Monday through Friday, 9 a.m. to 5 p.m.
  • Visit their website at: www.healthconsumer.org. By clicking on this link, you will be leaving the IEHP DualChoice website.
Get Help and Information from Livanta
  1. Call: 1-877-588-1123
    TTY: 1-855-887-6668
    For appeals: 1-855-694-2929
    For all other reviews: 1-844-420-6672
  2. Write to:
    Livanta LLC
    9090 Junction Drive, Suite 10
    Annapolis Junction, Maryland 20701
  3. Website: www.livanta.com By clicking on this link, you will be leaving the IEHP DualChoice website.

How to obtain an aggregate number of grievances, appeals, and exceptions filed with IEHP DualChoice MediConnect Plan (Medicare - Medicaid Plan)?
Please call or write to IEHP DualChoice Member Services.

  1. Call: 1-877-273-IEHP (4347). Calls to this number are free. 8am - 8pm (PST), 7 days a week, including holidays.
  2. TTY/TDD: 1-800-718-4347. This number requires special telephone equipment. Calls to this number are free.
  3. Fax: 1-909-890-5877
  4. Write:
    IEHP DualChoice
    P.O. Box 1800
    Rancho Cucamonga, CA 91729-1800
  5. Email: memberservices@iehp.org
  6. Visit:
    10801 Sixth Street, Suite 120
    Rancho Cucamonga, CA 91730

IIEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

Information on this page is current as of September 30, 2016

H5355_CMC_17_07258 Approved