Section 1371.39 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1371.39
. (a) Providers may report to the department's Office of
Plan and Provider Relations, either through the toll-free provider
line (877-525-1295) or e-mail address (plans-providers@dmhc.ca.gov),
instances in which the provider believes a plan is engaging in an
unfair payment pattern.
(b) Plans may report to the department's Office of Plan and
Provider Relations, either through the toll-free provider line
(877-525-1295) or e-mail address (plans-providers@dmhc.ca.gov),
instances in which the plan believes a provider is engaging in an
unfair billing pattern.
(1) "Unfair billing pattern" means engaging in a demonstrable and
unjust pattern of unbundling of claims, upcoding of claims, or other
demonstrable and unjustified billing patterns, as defined by the
department.
(2) The department shall convene appropriate state agencies to
make recommendations by July 1, 2001, to the Legislature and the
Governor for the purpose of developing a system for responding to
unfair billing patterns as defined in this section. This section
shall include a process by which information is made available to the
public regarding actions taken against providers for unfair billing
patterns and the activities that were the basis for the action.
(c) On or before December 31, 2001, the department shall report to
the Legislature and the Governor information regarding the
development of the definition of "unfair billing pattern" as used in
this section. This report shall include, but not be limited to, a
description of the process used and a list of the parties involved in
the department's development of this definition as well as
recommendations for statutory adoption.