Obtaining a DMHC License
All health care service plans must receive a license from the Department of Managed Health Care (DMHC) to operate in the state of California.
To become licensed, a health care service plan and pharmacy benefit manager must establish compliance with rules relating to health care service plan and pharmacy benefit manager operations and business practices as set forth in the Knox-Keene Act. In addition, some areas of regulation require health care service plans and pharmacy benefit managers to regularly report on operational measures to ensure ongoing compliance with the Act. The DMHC strives to streamline the process by providing resources so you can understand how to obtain and maintain a license, as well as ways to view and submit the forms and reports you need.
Some areas of regulation require health care service plans and pharmacy benefit managers to regularly report on operational measures to ensure ongoing compliance with the Act. The DMHC provides guidance and resources for the process of filing reports.
Provider Directory Standards
California law requires health plans to keep accurate provider directories. Health plans must publish and maintain accurate, complete and up-to-date provider directories. All health plans must have publicly available provider directories on their website, make weekly updates to those directories and provide consumers with simple ways to report directory errors. The DMHC monitors and reviews health plan compliance with Provider Directory Requirements.
The DMHC’s Uniform Provider Directory Standards under Health & Safety Code section 1367.27(k) are included below.
Uniform Provider Directory Standards - SB 137