PPO and indemnity products regulated by the California Department of Insurance (CDI) have no 365-day dispute-filing floor — that floor exists only on the DMHC side. On the CDI side the filing window is governed by your contract with the insurer, so the same payer can lawfully hold a shorter window here than on its HMO book. Insurers must still maintain a dispute process and issue a written determination within 45 working days.
Day types are not interchangeable: calendar, business, and month windows each count differently, and month windows are never converted to days. Every value below is quoted from its primary source.
Payer response clocks
Prompt pay insurer
30 calendar daysClock starts: date of receipt of claim
reimburse a complete claim or portion thereof … no later than 30 calendar days after receipt of the claim by the insurer
Prompt pay interest rate insurer
Procedural ruleClock starts: first calendar day after 30 calendar day period
interest shall accrue at the rate of 15 percent per annum beginning with the first calendar day after the 30-calendar-day period
Provider dispute determination CDI
45 working daysClock starts: date of receipt of dispute
dispute mechanism required for contracted and non-contracted providers; written determination within 45 working days; no 365-day floor on the CDI side (contrast 28 CCR § 1300.71.38(d)(1) on the DMHC side)
Source: Cal. Ins. Code § 10123.137
Reference information for provider billing teams, not legal advice. Windows depend on the plan's regulator and product, so confirm against your contracted provider manual. Sources retrieved 2026-07-04.