Healthcare
Health care coverage: claims payments
Starting May 26, 2028, health plans and insurers must accept claim-supporting medical records electronically and cannot hold up claims solely because their systems cannot receive the files.
The law aims to prevent technical submission barriers from delaying provider claims payments. It applies to regulated health care service plans and health insurers.
What the law does
- Requires plans and insurers to provide standard electronic methods for submitting medical records and other documentation needed to process claims.
- Requires electronic confirmation that the documentation was received.
- Requires file-size limits large enough for typical medical documentation used to decide claims.
- Bars denial, pend, or delay of a claim solely because the plan’s or insurer’s systems cannot accept otherwise compliant documentation.
- Applies a later state or federal standard governing file size, number, or other submission-capacity limits if one is adopted.
- Allows the Department of Managed Health Care and the California Department of Insurance to issue compliance guidance and regulations.
Who it affects
- Health care service plans and health insurers.
- Health care providers submitting claims and supporting medical records.
- Patients whose covered care generates claims.
Context
The law retains existing 30-day claims-payment and claims-notice requirements.