California Business and Professions Code

§ 511.4

BPC § 511.4 Effective Jan 1, 2006Div. 2 · Ch. 1 · Art. 1.5

Statute text

(a)A contracting agent, as defined in paragraph (2) of subdivision (d) of Section 511.1, shall beginning July 1, 2006, prior to contracting, annually thereafter on or before the contract anniversary date, and, in addition, upon the contracted provider’s written request, disclose to contracting providers all of the following information in an electronic format:

(1)The amount of payment for each service to be provided under the contract, including any fee schedules or other factors or units used in determining the fees for each service. To the extent that reimbursement is made pursuant to a specified fee schedule, the contract shall incorporate that fee schedule by reference, including the year of the schedule. For any proprietary fee schedule, the contract shall include sufficient detail that payment amounts related to that fee schedule can be accurately predicted.

(2)The detailed payment policies and rules and nonstandard coding methodologies used to adjudicate claims, which shall, unless otherwise prohibited by state law, do all of the following:

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Legislative history

Added by Stats. 2005, Ch. 441, Sec. 2. Effective January 1, 2006.