Health Net: New Law (AB 3275) to Establish Uniform Claim Reimbursement Standards

New standards to go into effect January 1, 2026

Beginning January 1, 2026, California law (AB 3275) will establish uniform claim reimbursement standards for all health care service plans and health insurers, which include Medi-Cal managed care plans.

Under this new law, plans must reimburse, contest, or deny complete (clean) claims within 30 calendar days of receipt. The prior standard of “working days” is replaced with calendar days.

If a claim is contested or denied, plans are required to send a written notice within 30 calendar days, explaining the reason for the action and any next steps.

This rule applies to all claims received on or after January 1, 2026, across both Department of Managed Health Care (DMHC)-regulated and Department of Insurance (DOI)-regulated lines of business.

Key Changes at a Glance

• 30 calendar days to pay, contest or deny a complete claim — applies to health care service plans regulated by DMHC and DOI. 
• If additional information is requested and submitted, the plan has 30 calendar days from receipt of the new information to re-adjudicate the claim.
• Written notice of contest or denial must be issued within 30 calendar days, clearly outlining the reason and next steps.
• Late payments:
  • Claims not paid within 30 calendar days will accrue interest at 15% per annum, starting on the 31st day.
  • Plans must automatically include all accrued interest in the payment — no separate request is required.
  • If interest is not automatically included, a penalty of no less than 10% of the accrued interest, or $15 (whichever is greater) applies.
  • Interest amounts under $2 may be aggregated and paid monthly, accompanied by an itemized list of claims.
• Provider disputes:
  • Determinations are due within 45 working days.
  • If the provider prevails, payment (including all interest and penalties) must be made within 5 working days.

Health Net's Commitment and Next Steps

The plan has an active internal workgroup in place to ensure full implementation of AB 3275 / APL 25-007 by January 1, 2026.