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://cchphealthplan.com/wp-content/uploads/2023/01/Claims-Payment-Policies-and-Practices_CCHP_01092023_v2.pdf

• California Dental Network

CDN Claims Payment Policy

• Dental Health Services

https://www.dentalhealthservices.com/files/2022_Transparency_in_Coverage_CA_FAQ.pdf

• 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

• Kaiser Permanente

Northern California:
https://healthy.kaiserpermanente.org/northern-california/community-providers/claims

Southern California:
Claims | Community Provider Portal | Kaiser Permanente

• 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

• Oscar

https://assets.ctfassets.net/plyq12u1bv8a/3feeZyZiBlhZQF8yOeTJJC/5f127b3010483507bd24ae7184a7066f/CA_TIC_FINAL_PY2023.docx.pdf

• Sharp Health Plan

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

• Valley Health Plan

https://www.valleyhealthplan.org/sites/g/files/exjcpb771/files/documents/Claims_Payment_Policies_and_Practices_08.02.22_2.pdf

• Western Health Advantage

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