Section 1371.39 - Report of unfair payment pattern or unfair billing pattern(a) Providers may report to the department through the toll-free provider line, email address, or another method designated by the department, instances in which the provider believes a plan is engaging in an unfair payment pattern.(b) Plans may report to the department through the toll-free provider line, email address, or another method designated by the department, instances in which the plan believes a provider is engaging in an unfair billing pattern.(c) "Unfair billing pattern" means engaging in a demonstrable and unjust pattern of unbundling of claims, upcoding of claims, or other demonstrable and unjustified billing patterns, as defined by the department.(d) On or before July 1, 2019, and at least annually thereafter, the department shall review complaints filed pursuant to subdivision (a). If the review of complaint data indicates a possible unfair payment pattern, the department may conduct an audit or an enforcement action pursuant to subdivision (s) of Section 1300.71 of Title 28 of the California Code of Regulations.Ca. Health and Saf. Code § 1371.39
Amended by Stats 2018 ch 303 (AB 2674),s 1, eff. 1/1/2019.Amended by Stats 2015 ch 303 (AB 731),s 260, eff. 1/1/2016.Added by Stats 2000 ch 827 (AB 1455), s 8, eff. 1/1/2001.Stats 2000 ch 825 (SB 1177), s 8also added this section.