The Health Care Provider complaints section is designed to assist with resolving complaints regarding improper denial or delay in payment of a claim, other claims handling issues, Dispute Resolution Mechanism difficulties, and misconduct of the health insurer.  Providers may submit complaints involving health care services rendered on or after January 1, 2006. The California Insurance Code defines health insurance as an individual or group insurance policy that provides coverage for hospital, medical, or surgical benefits.  Before you file a complaint with the California Department of Insurance, you must first submit the dispute to the insurer's Dispute Resolution Mechanism for a minimum of 60 calendar days or until receipt of the insurer's written determination, whichever period is shorter.  You must submit a separate Health Care Provider Request for Assistance (HPRFA) for each claim form submitted to the insurer.

The following steps are designed to provide health care providers with information and assistance: Step 1 - Jurisdictional Issues, Step 2 - Supporting Documents, Step 3 - Health Care Provider Request for Assistance Form (HPRFA).

• Step 1: Jurisdictional Issues