CA AB2157

Requires the Department of Managed Health Care and Department of Insurance to establish procedures allowing parties to submit confidential information to preserve source contract confidentiality in independent dispute resolution processes.

Mandates that independent organizations conducting dispute reviews perform de novo reviews based solely on timely submitted evidence and documents from both parties.

Requires independent organizations to assign case reviewers based on their relevant education, background, medical claims payment experience, and clinical experience.

Applies to disputes between health care service plans or health insurers and noncontracting individual health professionals, excluding Medi-Cal plans, emergency services, and entities contracting with the State Department of Health Care Services.

Approved by Governor September 29, 2020.