Provider Independent Dispute Resolution Process
What is AB 72?In 2016, California enacted legislation (AB 72) that protects consumers from "surprise" balance-bills when they receive care at an in-network facility for non-emergency services. If you are a consumer looking for information or help regarding a surprise bill that you received, please visit our No Surprise Bills consumer information page.
What is the Independent Dispute Resolution Process (IDRP)?AB 72 also requires insurers to reimburse non-contracting providers at a specified rate for services rendered at a contracted facility (125% of Medicare or the Average Contracted Rate for that region, whichever is greater) for non-emergency services. Additionally, if a provider believes that a higher payment is warranted, the California Department of Insurance operates the IDRP which allows a non-contracting individual health professional who provided non-emergency services in a contracted health facility to contest a payment amount. Please refer to the Department's Implementation Guidance AB72:2 for details about the IDRP applicability, process and program specifics.
Providers can submit a request for a binding IDRP to the Department using the IDRP Request Form. All of the relevant information about how to fill in and submit the form is included in this document. Providers must submit their claims via the Department's Provider Complaint Center.
If providers have any questions about their eligibility to participate or about any part of the process, please contact the Department's Help Line and we will assist you.