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(IDRP) Request Form - Department of Managed Health Care - State ... - dmhc ca

(IDRP) Request Form - Department of Managed Health Care - State ... - dmhc ca 2025

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The document is an IDRP (Independent Dispute Resolution Process) Request Form from the California Department of Managed Health Care. It outlines eligibility criteria for submitting a dispute regarding emergency services rendered by non-contracted providers, details required provider and payer information, and specifies supporting documentation needed to support the claim. The form also includes instructions for filing the request and a claim list for detailing individual claims.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the difference between DMHC and DHCs?

The Department of Health Care Services (DHCS) works with the Department of Managed Health Care (DMHC) to conduct routine medical surveys of Medi-Cal Managed Care Health Plans (MCPs) on selected populations on an annual basis.

How do I contact the DMHC?

For more information, go to .DMHC.ca.gov or call the Help Center at 1-888-466-2219. Free help is available in all languages. #DMHC #DMHCHelpCenter.

What is an IMR application complaint form?

An IMR is when an outside doctor who is not related to your health plan reviews your case. If you want an IMR, you must first file an appeal with L.A. Care. If you do not hear from your health plan within 30 calendar days, or if you are unhappy with your health plans decision, then you may request an IMR.

How do I contact the DMHC health plan?

If your plan does not resolve the issue within 30 days or you are not satisfied with your plans decision, contact the DMHC Help Center at .DMHC.ca.gov or at 1-888-466-2219.

How do I file a complaint against a Medi-Cal provider?

If you have a Medi-Cal Managed Care plan, you can call the Medi-Cal Managed Care Ombudsman at 1-888-452-8609 for guidance about how to address a problem or complaint. The office is open 8am-5pm/ Monday to Friday.