Health Care Providers Guide

4 Dispute Resolution Mechanism Before you file a complaint with the California Department of Insurance, you should first submit the dispute to the insurer’s Dispute Resolution Mechanism. Under the Dispute Resolution Mechanism process, disputes must be submitted to the insurer in writing and include the following information: provider name, provider tax identification number, patient name, insurer’s identification information, dates of service, description of dispute, and if applicable, billed and paid amounts. Insurers must provide the procedures for submitting a dispute through the Dispute Resolution Mechanism, including the location and telephone number where information regarding disputes may be submitted. Insurers must also ensure that a Dispute Resolution Mechanism is accessible to non-contracting providers for the purpose of resolving billing and claims disputes. Insurers are required to resolve each dispute and issue a written determination within 45 working days of the receipt of the provider’s dispute. . Before you submit a provider complaint