APPEALS
A provider has how many days from a denial or modification to submit an appeal?
What is 90 days?
This email box receives case management referrals.
What is CHACM@choc.org?
Extensions are never allowed for these authorizations.
What are Injectable Authorizations?
CHA no longer handles these requests as of July 1, 2026.
What are PCP Changes?
Lay Language must be entered for these four decision types.
What is Approvals, Denials, Modifications, and Redirects.
These three decision types can be appealed.
What are Modified, Denied, and Redirect/Carve-Out?
This person should be copied on all case management referrals.
Who is Liz Grant?
DME rentals are eligible for extensions.
What is False?
For PCP changes, members should be referred here.
What is CalOptima Member Services?
Before processing any retro authorization request, what must be verified first?
Member eligibility on the date of service.
A physician can request this discussion with the Medical Director regarding an authorization decision.
What is a Peer-to-Peer Review?
Providers can find the case management referral form at this location.
What is the CHA website/provider manual?
Most authorizations can be extended up to this many months from the authorization action date.
What is 8 months?
The age at which CalOptima Medi-Cal members age out of pediatric capitation.
What is 21 years old?
What email group is contacted to verify member eligibility?
What is CHOC_Elig?
A provider resubmits a denied request within 90 days and includes new clinical information.
What is a Provider Appeal?
Parents requesting case management should provide member name, DOB, phone number, and this.
What is a brief description of the reason for case management?
An authorization expired 20 days ago. It may still be processed as this.
What is an Extension Request?
An Out-of-Network Second Opinion requires review by this department.
What is clinical review?
What auth status is entered for an EZ-Net request when eligibility confirms the member is not active?
What is J - Pt is not eligible with IPA?
A member should contact this organization directly to file an appeal or grievance.
What is CalOptima?
This person conducts inpatient follow-up calls and can be reached at 714-509-7043.
Who is Frances Rocha?
An authorization expired more than this number of days ago and generally requires a new request.
What is 30 days?
An In-Network Second Opinion is processed using these guidelines.
What are Normal Authorization Guidelines?
What is the first action when EZ-Net documents do not match the selected member?
Verify it was submitted via EZ-Net and contact the provider office to cancel/resubmit correctly.