Health care coverage: claims payments.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Passed
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Overview
This bill, known as Adrienne’s Act, aims to improve health care claims payment processes within California’s health care system. Specifically, it requires health care service plans and insurers to accept electronic medical records and supporting documentation for claims processing and prohibits them from denying claims solely due to system limitations. It also clarifies procedures for contesting claims and outlines requirements for addressing suspected fraud within specialized vision care plans.
Key provisions
- Requires health plans and insurers to accept electronic medical records and supporting documentation for claims.
- Prohibits denial of claims based on system limitations for accepting electronic documentation.
- Establishes a process for specialized vision care plans to use statistical methods for fraud investigation and recovery.
- Mandates the Department of Corrections and Rehabilitation to develop rulemaking for occupational safety and health standards in correctional facilities.
- Clarifies the definition of a ‘reasonably contested’ claim.
- Updates procedures for interest accrual on unpaid claims.
- Addresses specific requirements for electronic submission and technical standards.
- Modifies sections related to claim reimbursement timelines and procedures.
Who is affected
- Health care service plans
- Health insurers
- Patients receiving health care services
Bill text
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Sponsors
Official sponsors from legislative records.
3 on record
Primary sponsor
Cosponsors
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