California CDI-regulated PPO and indemnity insurers: provider dispute deadlines (2026, verified)
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.
Per Appealant’s verified payer-deadline database, every value on this page is quoted verbatim from a primary source — the governing federal or California regulation — with the source linked and its effective date shown (sources re-retrieved 2026-07-04).
Calendar, business, and working days are not interchangeable, and month-based windows are never converted to day counts. Source documents were re-retrieved and verified 2026-07-04.
Full rules table, with verbatim sources
| Rule | Value | Clock starts | Applies to | Verbatim source text |
|---|---|---|---|---|
| Prompt pay insurer | 30 calendar days | date of receipt of claim | Payer / reviewer clock | reimburse a complete claim or portion thereof … no later than 30 calendar days after receipt of the claim by the insurer Cal. Ins. Code § 10123.13 (operative Jan. 1, 2026) (effective 2026-01-01) |
| Prompt pay interest rate insurer | 15 percent per annum (interest rate) | first calendar day after 30 calendar day period | Payer / reviewer clock | interest shall accrue at the rate of 15 percent per annum beginning with the first calendar day after the 30-calendar-day period Cal. Ins. Code § 10123.13 (operative Jan. 1, 2026) (effective 2026-01-01) |
| Provider dispute determination CDI | 45 working days | date of receipt of dispute | Payer / reviewer clock | 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) Cal. Ins. Code § 10123.137 (no stated effective date) |