1. (a) The provisions of this article shall establish the procedures for Department resolution of disputes concerning payment for emergency services rendered by non-plan providers to prepaid health plan members who are Medi-Cal beneficiaries.

2. (b) The procedures established in this article may be used to resolve disputes which meet all of the following requirements:

   1. (1) Arise out of services rendered after September 28, 1977.
   2. (2) Have not previously been resolved and are not presently the subject of litigation or arbitration.
   3. (3) Involve plans with current, active contracts with the Department.
3. (c) Nothing in this article shall be construed to give rise to any right of action or other claim against the Department.
4. (d) Prepaid health plans and nonplan providers shall not bill prepaid health plan members for services which are or have been the subject of review pursuant to this article.

Note: Authority cited: Sections 14312 and 14454, Welfare and Institutions Code. Reference: Section 14454, Welfare and Institutions Code.

History

1. New Article 7 (Sections 53620-53702, not consecutive) filed 6-12-79; effective thirtieth day thereafter (Register 79, No. 24).

2. Amendment filed 9-3-82; effective thirtieth day thereafter (Register 82, No. 36).