Grievances, Coverage Determination and Appeals Process

• You can call IEHP Member Services at 1-877-273-IEHP (4347) and ask for a Member Complaint Form. If you need help filling out the form, IEHP Member Services can assist you.
• You can complete the Member Complaint Form online.
• 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 fax the completed form to 909-890-5877. You can file a grievance online. This form is for IEHP DualChoice as well as other IEHP programs. 
• For some types of problems, you need to use the process for coverage decisions and making appeals.
  • Part C: Coverage Determination and Appeals
  • Part D: Coverage Determination and 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 having a problem with your care, you can call the Office of Ombudsman at 888-452-8609 for help.
• For problems and concerns regarding eligibility determinations, assessments and care delivered by our contracted Community Based Adult Services (CBAS) centers  or Nursing Facilities/Sub-Acute Care Facilities, you should follow the process outlined below.

• 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 fax the completed form to 909-890-5877. You can file a grievance online. This form is for IEHP DualChoice as well as other IEHP programs.

You can contact Medicare. Here are two ways to get information directly from Medicare:

• You can call (800) MEDICARE 1-800-633-4227, 24 hours a day, 7 days a week, TTY 1-877-486-2048.
• You can visit the Medicare website.

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 can call SHIP at 1-800-434-0222.

Get Help and Information from DHCS

• Call: 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 Office of the Ombudsman Program can answer your questions and help you understand what to do to handle your problem. The Office of the Ombudsman is not connected with us or with any insurance company or health plan. They can help you understand which process to use.

• Call: 1-888-452-8609 (TTY 711) Monday through Friday, 9 a.m.-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

Our state has an organization called Livanta Beneficiary & Family Centered Care (BFCC) Quality Improvement Organization (QIO). This is a group of doctors and other health care professionals who help improve the quality of care for people with Medicare. Livanta is not connected with our plan.

• Call: 1-877-588-1123, TTY 1-855-887-6668
• For appeals: 1-855-694-2929
• For all other reviews: 844-420-6672
• Write to:

  Livanta BFCC-QIO Program
  10820 Guilford Road, Suite 202
  Annapolis Junction, Maryland 20701

• Website: https://www.livantaqio.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 (HMO D-SNP)?

Please call or write to IEHP DualChoice Member Services.

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

CMS requires an annual health equity analysis to examine the impact of the use of prior authorization for members with social risk factors. 

The analysis compared two populations at the plan level using data from the prior contract year regarding coverage of items and services. The two populations included:

Population A: All members enrolled in the IEHP DualChoice plan

Population B: All IEHP DualChoice members with a disability status

The analysis includes the following metrics for each of the populations: 

(A) The percentage of standard prior authorization requests that were approved, aggregated for all items and services.

(B) The percentage of standard prior authorization requests that were denied, aggregated for all items and services.

(C) The percentage of standard prior authorization requests that were approved after appeal, aggregated for all items and services.

(D) The percentage of prior authorization requests for which the timeframe for review was extended, and the request was approved, aggregated for all items and services.

(E) The percentage of expedited prior authorization requests that were approved, aggregated for all items and services.

(F) The percentage of expedited prior authorization requests that were denied, aggregated for all items and services.

(G) The average and median time that elapsed between the submission of a request and a determination by the MA plan, for standard prior authorizations, aggregated for all items and services.

(H) The average and median time that elapsed between the submission of a request and a decision by the MA plan for expedited prior authorizations, aggregated for all items and services.

IEHP DualChoice (HMO D-SNP) is an HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) is dependent on contract renewal. This is not a complete list. 



Information on this page is current as of June 11, 2025.

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