CA SB537

Requires the administrative director to issue a report by January 1, 2023, comparing alternative payment systems (capitation, bundled payments, value-based systems) to the official medical fee schedule and recommending pilot programs.

Mandates publication of provider utilization data on the division's website by January 1, 2024, and annually thereafter, including physician names, specialties, number of injured workers treated, and utilization review modification or denial rates for physicians treating 10+ workers.

Revises the definition of "normal business day" for utilization review and prior authorization to explicitly exclude every Saturday, Sunday, and specified holidays (rather than Saturdays under certain circumstances).

Requires medical provider networks to post rosters of all participating providers on their websites by July 1, 2021, and establishes administrative director authority to investigate complaints and enforce compliance regarding network roster and internet address requirements.

Prohibits entities from altering or amending treatment authorization requests before submission to claims administrators, requires disclosure of reimbursement rates when contracted rates are more than 20% below the medical fee schedule, and mandates inclusion of national provider identifier numbers on payment requests.