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- DMHC Laws Regulations - California Department of Managed Health Care
The Knox-Keene Act can be found in California Health Safety Code, section 1340 et seq Additionally, regulations are used by the DMHC to implement, interpret, or make specific the laws enforced by the Department These regulations are codified under title 28 of the California Code of Regulations 2025 Knox-Keene Act and Title 28 Regulations
- Medi-Cal Managed Care: Appeals and Grievances
The Department of Managed Health Care (DMHC) can help you if you have a dispute with your health plan, including requesting an Independent Medical Review, reviewing grievances, and filing complaints
- AB 1455 Provider Claims Dispute Resolution California Code of . . .
Purpose of the Regulations: (1) describe what will constitute a “demonstrable and unjust” claims payment pattern, (2) define what constitutes a “complete and accurate claim”, and (3) define what constitutes a “fair, fast and cost-effective” provider dispute resolution process
- APL 21-011 - DHCS
The purpose of this All Plan Letter (APL) is to provide Medi-Cal managed care health plans (MCPs) with clarification and guidance regarding the application of federal and state legal requirements for processing grievances and appeals
- Appellate Victory For Medi-Cal Managed Care Plans
The decision, which is certified for publication, can be considered a victory for the entire Medi-Cal managed care community A copy of the appellate court decision is available here
- Department of Managed Health Care (DMHC) | CA. gov
If you disagree and believe you are being wrongfully billed, file a complaint with your plan If your plan does not resolve the issue within 30 days or you are not satisfied with your plan's decision, contact the DMHC Help Center at www DMHC ca gov(external link) or at 1-888-466-2219
- All Plan Letters - California Department of Managed Health Care
All Plan Letters (APLs) provide specific guidance and information to health plans regulated by the Department of Managed Health Care Browse APLs issued in the previous years
- Internal and External Review: Medi-Cal Managed Care Plans Managed Care . . .
Most—but not all—MCPs are also licensed by the California Department of Managed Health Care (DMHC) and are subject to a set of consumer protection laws called the ”California Knox-Keene Act” (KKA) 8 Certain other MCPs – called County Organized Health System (COHS) plans –are exempt from DMHC licensure 9 Likewise, MHPs and DMC-ODS
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