Health care providers are a crucial part of California's health care delivery system. Although the DMHC does not license or regulate providers or medical groups, we make sure that claims are paid fairly and timely.
The Claims Settlement Practices and Dispute Mechanisms Regulations were approved by the Office of Administrative Law on July 24, 2003, and are effective August 25, 2003. The Quarterly Claims Settlement Practices Report is required to be submitted for each licensed health care service plan. Health care service plans report claim information if the plan or any of its capitated providers has failed to timely reimburse at least 95% of complete claims with correct payment including interest and penalties due, that became payable during the reporting period.