AMENDED IN ASSEMBLY AUGUST 13, 2026

AMENDED IN SENATE APRIL 6, 2026

CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION

97

Introduced by Senator Weber Pierson

February 12, 2026

An act to add Section 1371.21 to the Health and Safety Code, and to add Section 10123.134 to the Insurance Code, relating to health care coverage.

Vote: majority   Appropriation: no   Fiscal committee: yes   Local program: yes

LEGISLATIVE COUNSEL’S DIGEST

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer to reimburse a complete claim or a portion thereof within 30 calendar days after receipt of the claim, or, if a claim or portion thereof does not meet the criteria for completeness, to notify the claimant no later than 30 calendar days after receipt that the claim or portion thereof is contested or denied.

This bill would grant a provider 90 claimant no less than 90 calendar days to submit a corrected claim after a health care service plan or health insurer denies a claim or portion thereof or sends a notice of overpayment for a claim based on a defect that may be remedied by submitting a corrected claim. The bill would prohibit a plan or insurer from denying a corrected claim on the grounds that the provider did not submit the claim was not submitted within another applicable claim filing deadline. Under the bill, a dispute related to a corrected claim would be required to be eligible for submission to the plan’s or insurer’s fast, fair, and cost-effective dispute resolution mechanism. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

The people of the State of California do enact as follows:

SECTION 1.

Section 1371.21 is added to the Health and Safety Code, to read:

1371.21.

(a) Notwithstanding any other law, if a health care service plan denies a claim or portion thereof or sends a notice of overpayment for a claim based in whole or in part on a defect that may be remedied by submitting a corrected claim, the provider claimant shall have 90 no less than 90 calendar days from the plan’s most recent action to submit a corrected claim.

(b) A plan shall not deny a corrected claim submitted pursuant to this section and in accordance with subdivision (a) on the grounds that the provider did not submit the claim was not submitted within an applicable claim filing deadline other than the deadline specified in subdivision (a). A dispute related to a corrected claim submitted pursuant to this section shall be eligible for submission to the plan’s fast, fair, and cost-effective dispute resolution mechanism.

SEC. 2.

Section 10123.134 is added to the Insurance Code, to read:

10123.134.

(a) Notwithstanding any other law, if a health insurer denies a claim or portion thereof or sends a notice of overpayment for a claim based in whole or in part on a defect that may be remedied by submitting a corrected claim, the provider claimant shall have 90 no less than 90 calendar days from the insurer’s most recent action to submit a corrected claim.

(b) An insurer shall not deny a corrected claim submitted pursuant to this section and in accordance with subdivision (a) on the grounds that the provider did not submit the claim was not submitted within an applicable claim filing deadline other than the deadline specified in subdivision (a). A dispute related to a corrected claim submitted pursuant to this section shall be eligible for submission to the insurer’s fast, fair, and cost-effective dispute resolution mechanism.

SEC. 3.

No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.