Claims Payment Policies and Practices

Qualified Health and Dental Plan Issuers have provided information to help you understand what is needed for a claim to be paid, or why a claim was denied.

Click the links below to see the information the issuers have provided.

• Aetna CVS Health

• How an individual health plan works (aetna.com)

• Anthem Blue Cross

• https://www.anthem.com/ca/ms/claims/home.html

• Blue Shield of California Qualified Health Plan

• Claims Payment Policy and Practices for Qualified Health Plans (QHP)

• Blue Shield of California Qualified Dental Plan

• Claims Payment Policy and Practices for Qualified Dental Plans (QDP)

• CCHP Health Plan

• https://balancebycchp.com/claims-payment-policies-and-practices/

• California Dental Network

• CDN Claims Payment Policy

• Delta Dental

• https://www.deltadentalins.com/hcx/how-your-marketplace-plan-works.html

• Health Net

• https://ifp.healthnetcalifornia.com/learn-more/claims-for-covered-services.html

• Humana

• https://www.humana.com/member/plain-language-policy

• Inland Empire Health Plan

• https://www.iehp.org/en/legal-and-privacy/transparency-in-coverage.html

• Kaiser Permanente

• Northern California:

  https://healthy.kaiserpermanente.org/northern-california/front-door/machine-readable

  Southern California:

  https://healthy.kaiserpermanente.org/southern-california/front-door/machine-readable

• LA Care Health Plan

• https://www.lacare.org/health-plans/la-care-covered/claims-payment-policy-and-practices

• Molina Healthcare

• https://www.molinamarketplace.com/marketplace/ca/en-us/FAQ.aspx

• Sharp Health Plan

• https://www.sharphealthplan.com/our-plans/how-health-insurance-works/claims-payment-policies-and-practices

• Valley Health Plan

• https://files.santaclaracounty.gov/2024-07/m-claimspaymentpoliciesandpractices-en-082024.pdf?VersionId=HKhY2GrLlagsyux1ezGgbRvEyvWZzD5A

• Western Health Advantage

• https://www.westernhealth.com/pdfs/member-downloads/claims-payment-policies-and-practices/