Verified October 10, 2026 against the statutes, regulations and sources cited below. General information, not legal advice. All states
What providers miss in California
- The 2027 provisional approval does not reach a clinician the plan has not credentialed in the past five years, so it helps returning providers far more than first-time applicants.
- DHCS says Medi-Cal plans generally have discretion to contract or not with any enrolled provider and need no appeal process for those decisions. A plan screening a provider must give a written determination within 120 days. Discrimination concerns go to the DHCS Office of Civil Rights.
- DMHC reviews a provider complaint only after the plan's dispute process has run 45 working days or produced a written decision. The Department of Insurance also asks providers to use the insurer's dispute process first.
Does California have an any willing provider law?
No provider-wide any willing provider statute was confirmed for California.
How long can a plan take to credential a provider in California?
From January 1, 2027, plans and insurers must decide on credentials within 90 days of a completed application, including third-party verifications, and confirm receipt within 10 business days. The clock covers credentialing only, not contracting. Behavioral health credentialing has had a 60-day limit since 2023.
- Deadline: 90 days
- Applies to: Knox-Keene health plans and health insurers and their delegates; all providers. Behavioral health plans already have 60 days (since 2023). Medi-Cal contracts are excluded.
Citation: Cal. Health & Safety Code §§ 1374.197, 1374.198; Cal. Ins. Code § 10144.565
Can a provider practice in network while California plans credential them?
From 2027, a missed 90-day deadline means 120 days of provisional approval, unless the applicant faces licensing discipline, has NPDB adverse action or malpractice payment reports, or has not been credentialed by that plan in the past five years.
- Provisional or interim credentialing
Citation: Cal. Health & Safety Code § 1374.198(a); Cal. Ins. Code § 10144.565
What network adequacy rules apply in California?
Knox-Keene plans must have enough providers to offer appointments within set times: 10 business days for primary care and non-physician mental health care, 15 for specialists, and 48 hours for urgent care without prior authorization. Ratio and distance rules in Title 28 also apply.
Citation: Cal. Health & Safety Code § 1367.03; 28 CCR 1300.67.2, 1300.67.2.1
Out-of-network coverage when mental health care is not timely
If medically necessary mental health or substance use treatment is not available in network within the time and distance standards, a Knox-Keene plan must arrange coverage outside its network.
Citation: Cal. Health & Safety Code §§ 1367.03(a)(7), 1374.72(d)
Will the California insurance department take a provider complaint?
- California Department of Insurance (insured PPO and indemnity plans); Department of Managed Health Care regulates HMOs and Knox-Keene plans
Who oversees Medicaid managed care plans in California?
- California Department of Health Care Services (Medi-Cal)
Turned down by a plan in California?
We read the denial, check which of these rules reach that plan, and prepare the reconsideration request, the access-gap evidence and any regulator complaint the law supports; you sign and send them, and we track every deadline. Self-funded employer plans follow federal law, not California's. A rejection review is $249, credited toward a dispute.