25-729 Claims Will Be Paid Faster Thanks to New California Law
Date: 07/23/25
Assembly Bill (AB) 3275 puts forth updated timelines for claims reimbursement and penalties for non-adherence
Starting January 1, 2026, claims must be reimbursed fully or partially within 30 calendar days of receipt. If a claim is incomplete, the physician or other provider must be notified as soon as possible, and no later than 30 calendar days after receiving the claim. As such, participating physician groups (PPGs) and hospitals delegated to pay claims are required to reimburse a complete claim or portion thereof with a date of receipt on or after January 1, 2026, within 30 calendar days.
See below for more information about these upcoming changes so PPGs and hospitals delegated for claims can prepare.
Interest and penalty payments required for claims not paid on time
Complete claims must be paid within 30 calendar days of receipt to avoid a late interest payment.
Starting January 1, 2026, late paid claims must include interest at the rate of 15% per annum beginning with the first calendar day after the 30-calendar day period.
Also, starting January 1, 2026, late paid claims must include a penalty payment to the claimant the greater of either an additional $15 or 10% of the accrued interest on the claim.
Notices about incomplete claims (claim denials or contestations)
As of January 1, 2026, PPGs and hospitals delegated to pay claims must notify the member and provider in writing within 30 calendar days from receipt of the claim of an incomplete claim. Notices must specify:
- Date of denial notice
- Member name
- Provider name
- Specific service
- Date of service
- Denied amount
- Member responsibility amount
- Reason for the denial - Claim denials for members must include a claim denial message.
- Provider and member appeals process and information, including plan name, address and telephone number for appeals.
Member complaints must be treated as grievances
Also starting January 1, 2026, member complaints about a delay or denial of payment of a claim must be treated as a grievance subject to the Health Net grievance process.
You can access information about the grievance process in the provider operations manual, available in the Provider Library. Once in the library, select the applicable line of business > Provider Manual > Appeals, Grievances and Disputes > Grievances.
Additional information
The DMHC may issue additional guidance on AB 3275 until December 31, 2027. Impacts to providers will be communicated accordingly.
For additional details on AB 3275 please visit Assembly Bill No. 3275.
Relevant sections of Health Net’s provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on Health Net’s provider portal.
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.
Provider Services
Line of business | Phone number |
Ambetter from Health Net IFP Ambetter PPO | |
Ambetter HMO | |
Health Net Employer Group HMO, POS, & PPO | |
Medi-Cal (including CS and ECM providers) |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary Providers.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.