ARTICLE 9.5. Claims Reviewers [1399.55. - 1399.57.]

Cal. Health and Safety Code - HSC 9.5.
in effect

Cal. Health and Safety Code - HSC § 1399.55. Section 1399.55.

Health care service plans shall, upon rejecting a claim from a health care provider or a patient, and upon their demand, disclose the specific rationale used in determining why the claim was rejected. Nothing in this section is intended to expand or restrict the ability of a health care provider or a patient from having health care coverage approved in advance of services.

Cal. Health and Safety Code - HSC § 1399.56. Section 1399.56.

Compensation of a person retained by a health care service plan to review claims for health care services shall not be based on either of the following: (a) A percentage of the amount by which a claim is reduced for payment. (b) The number of claims or the cost of services for which the person has denied authorization or payment.

Cal. Health and Safety Code - HSC § 1399.57. Section 1399.57.

This article does not apply to services or benefits provided pursuant to Medi-Cal, including services or benefits provided under Chapters 7 (commencing with Section 14000) and 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
Source: CA Legislative Counsel Bulk DataURL: https://downloads.leginfo.legislature.ca.gov/pubinfo_2025.zipFetched: 6/27/2026

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