Health plans regulated by the California Department of Managed Health Care (DMHC) — HMOs and other Knox-Keene-licensed products — may not impose a provider-dispute filing deadline shorter than the 365-day floor in 28 CCR § 1300.71.38(d)(1). That floor applies to DMHC-regulated business regardless of what the payer's national policy says. Which regulator governs a claim depends on the product, not the payer name.
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.
Deadlines you must hit
Provider dispute filing window
365 calendar daysClock starts: date of plan action or inaction deadline
Neither the plan nor the plan's capitated provider that pays claims, except as required by any state or federal law or regulation, shall impose a deadline for the receipt of a provider dispute for an individual claim, billing dispute or other contractual dispute that is less than 365 days of plan's or the plan's capitated provider's action or, in the case of inaction, that is less than 365 days after the Time for Contesting or Denying Claims has expired.
Source: 28 CCR § 1300.71.38(d)(1)
Medical necessity UM appeal to plan
60 working daysClock starts: capitated provider date of determination
The plan's contract with a capitated provider shall provide that any provider that submits a claim dispute to the plan's capitated provider's dispute resolution mechanism(s) involving an issue of medical necessity or utilization review shall have an unconditional right of appeal for that claim dispute to the plan's dispute resolution process for a de novo review and resolution for a period of 60 working days from the capitated provider's Date of Determination, pursuant to the provisions of section 1300.71.38(a)(4) of title 28.
Source: 28 CCR § 1300.71(e)(5) (DMHC AB1455 Full Regulation text)
Payer response clocks
Provider dispute acknowledge electronic
2 working daysClock starts: date of receipt of dispute
(e)(1) In the case of an electronic provider dispute, the acknowledgement shall be provided within two (2) working days of the date of receipt of the electronic provider dispute by the office designated to receive provider disputes
Source: 28 CCR § 1300.71.38(e)(1)
Provider dispute acknowledge paper
15 working daysClock starts: date of receipt of dispute
(e)(2) In the case of a paper provider dispute, the acknowledgement shall be provided within fifteen (15) working days of the date of receipt of the paper provider dispute by the office designated to receive provider disputes.
Source: 28 CCR § 1300.71.38(e)(2)
Provider dispute resolution written determination
45 working daysClock starts: date of receipt of dispute
(f) Time Period for Resolution and Written Determination. The plan or the plan's capitated provider shall resolve each provider dispute or amended provider dispute … and issue a written determination stating the pertinent facts and explaining the reasons for its determination within 45 working days after the date of receipt of the provider dispute or the amended provider dispute.
Source: 28 CCR § 1300.71.38(f)
Prompt pay all plans
30 calendar daysClock starts: date of receipt of claim
shall reimburse a complete claim or portion thereof, whether in state or out of state, as soon as practicable, but no later than 30 calendar days after receipt
Source: Cal. Health & Safety Code § 1371(a)(1) (operative Jan. 1, 2026)
Prompt pay interest rate
Procedural ruleClock starts: first calendar day after 30 calendar day period
interest shall accrue at a rate of 15 percent per annum beginning with the first calendar day after the 30-calendar-day period
Source: Cal. Health & Safety Code § 1371(a)(4) (operative Jan. 1, 2026)
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.