Treatment Authorization Request (TAR) Appeals
The Tar Administrative Remedy Section (TARARS) adjudicates all Treatment Authorization Request (TAR) appeals for services provided to beneficiaries in the fee-for-service Medi-Cal program. Providers send TARs to the local or regional Field Office (F.O.) for authorization of elective services or for approval of urgent/emergent services already rendered.
TARARS staff review the documentation submitted by the provider and render a final decision. If the original denial by the F.O. is upheld or modified and the provider is not satisfied with the decision, they have the right to seek a judicial remedy.
Appeals must be submitted to TARARS within 180 days of the date of the original TAR decision.
How To Appeal a TAR Decision
Effective April 1, 2007, Regulation Package R-48-01, “Treatment Authorization Requests (TARs)”, collapses the TAR appeal process into a single level of appeal.
For Appeals of TAR Decisions Made Prior to April 1, 2007
Appeals of TAR decisions made prior to April 1, 2007 will continue to be processed according to the two-level appeal process. Please see the Provider Manual for submission instructions.
For Appeals of TAR Decisions Made On or After April 1, 2007
Appeals of TAR decisions made on or after April 1, 2007, are to be forwarded to the TAR Administrative Remedy Section, located in the Medi-Cal Operations Division Headquarters. Providers now have 180 days from the TAR decision date (action date) to submit the single level appeal. Submit these appeals to the following address:
Medi-Cal Operations Division Headquarters
TAR Administrative Remedy Section
1501 Capitol Avenue, Suite 71-3002
P.O. Box 997419
Sacramento, CA 95899-7419
Submit the following documentation with the appeal:
- A copy of the original denied or modified TAR, and service type requested;
- Date(s) or service(s) in dispute;
- Reason the appeal should be granted;
- Any additional documentation in addition to the medical record, that the provider chooses to submit that supports the basis for the conclusion that the services are medically necessary; and
- A new, completed TAR for the services appealed.
For questions, please call the TAR Administrative Remedy Section at (916) 552-9110 and ask to speak to the Resource Supervisor