Quick answer: California primarily uses its own IDR process. For non-emergency services at in-network facilities, California's AB 72 Independent Dispute Resolution Process (IDRP) governs — run through the Department of Managed Health Care (DMHC) and Department of Insurance (CDI), not the federal portal. Federal IDR applies mainly to self-funded ERISA plans and air ambulance claims, which California can't regulate directly.
California enacted AB 72 in 2016, well before the federal No Surprises Act existed. It requires health plans to reimburse non-contracting providers at a specified rate — 125% of Medicare or the average contracted rate, whichever is greater — for non-emergency services at in-network facilities. If a provider believes a higher payment is warranted, they file through the AB 72 IDRP, administered electronically through a third-party reviewer. Fully-insured plans regulated by DMHC or CDI use this state process almost exclusively for non-emergency disputes.
Emergency services and Medi-Cal managed care are handled separately and are not covered under AB 72's IDRP. Air ambulance claims and self-funded ERISA plans fall outside California's authority, so those default to the federal IDR process instead.
AB 72 protections began July 1, 2017. Federal No Surprises Act protections layered on top starting January 1, 2022, primarily affecting self-funded plans and air ambulance services that state law can't reach.
Current AB 72 fee schedule, which plan types are exempt, and how state and federal processes interact for your specific claim type — all in one AI-powered lookup.
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