Timely Payment of Claims
| Date: | July 21, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan Select Providers and Practitioners |
| Type: | Regulatory |
| Subject: | Timely Payment of Claims |
| Business: | Medi-Cal Managed Care |
Beginning January 1, 2026, in accordance with the Department of Managed Health Care (DMHC) APL 25-007 – Assembly Bill 3275, upon receipt of a Complete Claim, payment or denial will be made within thirty (30) calendar days. Health Plan shall notify Providers in writing no later than thirty (30) calendar days after receipt of a claim. If a portion and/or whole claim has been contested (denied), the notice will identify the portion of the claim that is contested (denied) and the specific reason Health Plan is contesting the claim.
If the claim is contested (denied) because Health Plan has not received the information necessary to determine Health Plan liability for the claim, then the Provider will have thirty (30) calendar days from the date of the notice to provide the information requested. Heath Plan will then complete its consideration of the claim within thirty (30) calendar days after receiving the requested information.
If an uncontested claim is not reimbursed by delivery to the provider’s address of record within 30 calendar days after receipt, interest accrues at 15% per annum, beginning with the first calendar day after the 30-calendar day period.
If the interest payment is not included in the claim payment or paid within 5 working days of the claim payment, Health Plan pays the provider an additional fifteen dollars ($15) or ten percent (10%) of the accrued interest on the claim. The requirement for interest and penalty applies to all claims, including claims for emergency services and care.
In the event that the interest due on an individual late claim payment is less than $2.00 at the time that the claim is paid, Health Plan may pay the interest on that claim along with interest on other such claims within ten (10) calendar days of the close of the calendar month in which the claim was paid, provided the Health Plan includes, with the interest payment, a statement identifying the specific claims for which the interest is paid, setting forth the method for
calculating interest on each claim and documenting the specific interest payment made for each claim.
For further guidance, see APL 25-007 (OFR) – Assembly Bill 3275 Guidance (Claim Reimbursement)
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
