When a claim is paid late, health plans (or their contracting medical groups/IPAs) must make interest payments—without the need for any reminder or request—to physicians no more than five working days after the claim is paid. Health plans that fail to make automatic interest payments (calculated at 15 percent a year) must pay an additional $10 penalty per claim.

If the interest due on an individual claim is less than $2, the plan can wait until the close of the calendar month and make a lump interest payment for all late claim payments during that time period. Lump interest payments must be made within 10 calendar days of the month’s end.

It is important for physicians to report unfair health plan payment practices to the Department of Managed Health Care (DMHC), so the department can take action against plans (and their contracting medical groups/IPAs) that fail to comply with the new regulations. Provider complaint forms are available in the Unfair Payment Practices Resource Center.

Please contact CMA’s Center for Economic Services at 888/401-5911 prior to submitting a complaint to get help with filing the appropriate forms and supporting documentation to substantiate the complaint.

Please also fax a copy of your complaint to CMA’s Center for Economic Services at 916/551-2027. This will allow CMA reimbursement specialists to monitor DMHC enforcement.