Part 2.7Medical Claims Data Error Correction

Section § 57

Explanation

This law section states that certain organizations, which are allowed to receive claims data from health insurance plans, must follow specific federal rules for handling requests to correct errors in that data. It applies to all claims data, even beyond Medicare. It also defines 'providers' as hospitals and similar facilities and 'suppliers' as doctors or other health care service providers.

(a)CA Civil Law Code § 57(a) A qualified entity, as defined in Section 1395kk(e)(2) of Title 42 of the United States Code, that receives claims data from a health care service plan or health insurer shall comply with the requirements governing provider and supplier requests for error correction established under Section 401.717 of Title 42 of the Code of Federal Regulations for all claims data received, including data from sources other than Medicare.
(b)CA Civil Law Code § 57(b) For purposes of this section, the following definitions apply:
(1)CA Civil Law Code § 57(b)(1) “Provider” means a hospital, a skilled nursing facility, a comprehensive outpatient rehabilitation facility, a home health agency, a hospice, a clinic, or a rehabilitation agency.
(2)CA Civil Law Code § 57(b)(2) “Supplier” means a physician and surgeon or other health care practitioner, or an entity that furnishes health care services other than a provider.
qualified entity claims data health care service plan health insurer error correction provider definition supplier definition federal regulations Medicare data Title 42 Code of Federal Regulations health care services Section 401.717 Medicare claims hospital data
(Added by Stats. 2012, Ch. 869, Sec. 1. (SB 1196) Effective January 1, 2013.)