DMHC issues guidance for California health plans

March 11, 2024

As a direct result of California Medical Association (CMA) advocacy, the California Department of Managed HealthCare (DMHC) is strongly encouraging health plans to accept paper claims. In All Plan Letter 24-005, issued today, DMHC told plans in order to prevent further payment delays they should waive any requirements to submit claims electronically, and should automatically accept paper claims from providers, until Change Healthcare resumes operations or suitable electronic workarounds have been established.

The guidance also encourages plans to remove or relax timely claim filing requirements, given the difficulty – or in some cases, impossibility – of submitting claims at this time. DMHC said, however, that this does not relieve plans of their timely payment responsibilities, and advised that plans  should  establish workarounds to ensure claims are paid within the statutory timeframes.

At CMA’s urging, DMHC is also encouraging plans to remove or relax prior authorization and other utilization management requirements, to ensure that patient care is not delayed as the cyberattack and resulting outages continues to impact the ability of some providers to submit prior authorization requests.


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