California Timely Filing Law

Overview

California Code of Regulations §1300.71 sets strict timely filing deadlines for health plans. Electronically submitted claims must be processed within 15 days; all other claims within 30 days of receipt. Unpaid claims after the deadline accrue interest at 15% per year. The California Department of Managed Health Care (DMHC) enforces these requirements.

Key Requirements

1. Electronically submitted clean claims must be processed within 15 days of receipt.
2. All other clean claims must be processed within 30 days of receipt.
3. Interest accrues at 15% per annum on unpaid claims after the deadline passes.
4. Plans must document receipt date to establish the timely filing deadline.
5. Incomplete claims must be rejected within the deadline with itemized list of missing information.

Penalties and Enforcement

DMHC enforces timely filing violations with administrative penalties and fines. Plans that systematically fail to meet deadlines face regulatory orders, license restrictions, and corrective action mandates. The 15% interest requirement compounds late-payment penalties, creating strong incentives for timely processing. Consumers can file complaints with DMHC for violations.

Appeals and Exceptions

Timely filing denials can be appealed directly to the plan and escalated to DMHC for review. No exceptions exist for incomplete claims submitted on time; plans must request additional information within the deadline. Providers can challenge deadline calculations through DMHC dispute processes.

Interaction with Federal Law

California timely filing requirements apply to HMOs and PPOs regulated by DMHC. Federal ERISA rules for self-funded plans require 30-day decisions, matching California's non-electronic standard. California enforcement is more aggressive than federal minimum standards.

Common Questions