Appeals & Disputes

Members can learn how to file a Member Appeal by visiting our File a Grievance web page.

Members and Providers acting on behalf of a Member have many ways to file a grievance with L.A. Care. Members needing assistance with filing a grievance can call the L.A. Care Customer Solution Center at the number located on the back of their Member identification card, 24 hours a day, 7 days a week, including holidays.

Members and Providers can also use the following methods to file a grievance:

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By mail

L.A. Care Health Plan  
Attn: Appeals and Grievances Department 
1200 W. 7th Street
Los Angeles, CA 90017

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By Phone

For L.A. Care Covered and L.A. Care Covered Direct Members
Customer Solutions Center: 1-855-270-2327 (TTY 711)

For Medi-Cal Members
Customer Solutions Center: 1-888-839-9909 (TTY 711)

For PASC-SEIU Health Plan Members
Customer Solutions Center: 1-844-854-7272 (TTY 711)

For D-SNP Members
Customer Solutions Center 1-833-522-3767 (TTY 711) 

Provider Disputes

L.A. Care will consider the following Provider disputes:

  • Adjusted claims
  • Contested claims
  • Denied claims
  • Disputing a request for reimbursement of an overpayment to a claim
  • Payment of a claim
  • Seeking resolution of a payment determination
  • Seeking resolution of other contract disputes relative to claims processing

Providers should submit a written notice to L.A. Care via US mail or another physical delivery for a dispute relating to the adjudication of a claim or a billing determination.

Download our Provider Dispute Resolution Request forms.

For Second Level Disputes, please visit our Claims web page.

Additional Resources
Claims
File a Grievance
Manuals and Forms