CA AB510

Allows healthcare providers to request a peer-to-peer review when a health care service plan or insurer delays, denies, or modifies a health care service based on medical necessity

Requires the peer reviewer to be a licensed physician (or licensed health care professional if the requesting provider is not a physician) who is competent in the specific clinical issues and is of the same or similar specialty as the requesting provider

Mandates that peer-to-peer reviews occur within 2 business days of the request, or within 24 hours if the patient faces an imminent and serious threat to their health

Automatically deems the health care service request approved if the plan or insurer fails to meet the required review timelines, superseding any prior denial, delay, or modification

Applies to both health care service plans regulated by the Department of Managed Health Care and disability insurers regulated by the Department of Insurance