Section 127585 Of Chapter 3. Uniform Billing Format From California Health And Safety Code >> Division 107. >> Part 2. >> Chapter 3.
127585
. (a) Carriers shall accept, and providers shall use, a
completed California uniform billing form, or the electronic
equivalent, for each instance when a carrier provides coverage for
professional health care services and for each instance when a
carrier provides coverage for institutional provider services.
(b) Carriers that are health care service plans licensed under the
Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code), and providers of professional health care services or
institutional provider services covered by those plans shall be
exempt from the requirement of subdivision (a) except in instances
when the provider of the professional health care services bills the
plan for the specific services provided and in instances when the
provider of the institutional provider services bills the plan for
the specific services provided.
(c) Nothing in the forms shall be construed to prohibit a carrier
from requiring that its insured or enrollee, or a person acting on
behalf of the insured or enrollee, submit other information to the
carrier as necessary to determine that the professional health care
services or institutional provider services are covered under the
terms of the carrier's health benefits plan.