CA AB2674

Requires the Department of Managed Health Care to review complaints of unfair payment patterns by health care service plans on or before July 1, 2019, and at least annually thereafter.

Authorizes the department to conduct an audit or enforcement action if the complaint review indicates a possible unfair payment pattern.

Defines "unfair billing pattern" as a demonstrable and unjust pattern of unbundling claims, upcoding claims, or other unjustified billing patterns as defined by the department.

Allows providers to report suspected unfair payment patterns to the department through a toll-free provider line, email, or other designated method.

Allows plans to report suspected unfair billing patterns by providers to the department through similar reporting channels.