Practices that have still not received retroactive payments for COVID-19 services as required under SB 510 should submit complaints to the California Department of Managed Health Care (DMHC) through its provider complaint portal.

Please note that while DMHC requires most complaints to be submitted within 4 years of the date of service, the California Medical Association (CMA) has been working with DMHC to ensure that SB 510-specific claims older than that date can still be submitted. If you are submitting COVID-19/SB 510 claims that are over four years old, contact the DMHC Provider Complaint Section at (877) 525-1295 or providercomplaintunit@dmhc.ca.gov for instructions.

When submitting a complaint through DMHC’s provider complaint portal, there is no SB 510/COVID-19 specific category in the “Nature of Complaint” dropdown, so it is imperative that all COVID-19 related submissions include an explanation of the nature of the complaint in the designated narrative section that asks the submitter to explain their dispute.

About SB 510

CMA-sponsored Senate Bill 510 (2021), authored by Senator Richard Pan, M.D., requires health plans and insurers to reimburse providers for COVID-19 testing, immunization and related services. The law also prohibits health plans and insurers from shifting the financial risk for COVID-19 testing, vaccine administration and related services to contracted providers, unless both parties have negotiated and agreed to a new contractual provision. Though the law took effect January 1, 2022, it applied retroactively to claims dating back to March 4, 2020, the beginning of California’s public health emergency for COVID-19, to ensure that health plans and insurers that failed to make appropriate payments for COVID-19 testing in the early months of the pandemic would be required to pay for the testing.

Some retroactive claims payments were further delayed when the California Association of Health Plans (CAHP) filed a lawsuit in November 2021, challenging retroactive enforcement of SB 510 on constitutional grounds. Though CAHP had obtained a preliminary injunction on the law’s retroactivity, the trial court ultimately ruled in favor of the law, upholding the validity of SB 510’s retroactive provisions.

Need Help?

Physicians who are still having trouble getting paid for outstanding COVID-19 testing, immunizations and related services are encouraged to contact CMA’s Center for Economic Services at (800) 786-4262 or economicservices@cmadocs.org.