On July 26, the Department of Health Care Services (DHCS) released an All-Plan Letter reminding Medi-Cal managed care plans of their responsibility to pay providers on a timely basis.
This letter, which follows March guidance from the Department of Managed Health Care that was prompted by CHA advocacy, demonstrates continued engagement and concern from state regulators that plans are not meeting their basic responsibility of promptly paying for the care their members receive.
The DHCS guidance clarifies the various obligations of Medi-Cal plans under state and federal law, which include:
- That plans and their subcontractors pay any uncontested claim within 30 working days of claim submission
- A provider is entitled to interest when an uncontested claim is not paid within 30 working days
- That plans have sufficient dispute resolution processes in place for contracted and non-contracted providers, including with respect to timely claims processing
DHCS encourages Medi-Cal plans to go beyond their minimum legal obligations for timely payments, to the extent feasible, in order to support access to care and provider sustainability.
CHA remains focused on improving the timeliness of payments. Questions or inquiries can be directed to Ben Johnson at firstname.lastname@example.org.