AB1455

The Department of Managed Health Care enacted regulations related to claims settlement and dispute resolution practices of health plans and their delegated IPAs/Medical Groups ("AB1455 Regulations"). Among other things, the AB 1455 Regulations require IPAs/Medical Groups that are delegated for claims processing and dispute resolution to send a notice to their downstream contracted providers outlining the IPA/Medical Group's claim settlement and dispute resolution practices ("AB1455 Notice").

Please find below Alameda Alliance for Health (Alliance) disclosure notice that includes detailed information on how to submit claims and disputes to the Alliance as well as information on the Alliance's claim overpayment process along with the downloadable dispute submission form.

For further information on the AB1455 Regulation, please refer to the Department of Managed Health Care's website address: www.dmhc.ca.gov/library/regulations/existing and see the table for "Claims Settlement Practices/Dispute Resolution Mechanism" for a copy of the specific provisions.

If you have any questions regarding this information, please contact the Alliance Claims Department at 510-747-4530.

Claims Settlement Practices

Claims Dispute Mechanism

Provider Dispute Resolution Submission Form

Provider Notification-Timely Filing Requirments

Provider Notification-Timely Filing Requirments OB