California Health and Safety Code

§ 1366.4

HSC § 1366.4 Effective Jan 1, 2010Div. 2 · Ch. 2.2 · Art. 4

Statute text

(a)A medical group, physician, or independent practice association that contracts with a health care service plan may enter into contracts with licensed nonphysician providers to provide services, as defined in Section 1300.67(a)(1) of Title 28 of the California Code of Regulations, to plan enrollees covered by the contract between the plan and the group, physician, or association.

(b)The licensed nonphysician provider described in subdivision (a) that contracts with a medical group, physician, or independent practice association may directly bill, if direct billing is otherwise permitted by law, a health care service plan for covered services pursuant to a contract with the health care service plan that specifies direct billing. Direct billing pursuant to this subdivision is permitted only to the extent that the same services are not billed for by the medical group, physician, or independent practice association.

(c)A health care service plan may require the nonphysician provider to complete an appropriate credentialing process.

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Legislative history

Amended by Stats. 2009, Ch. 298, Sec. 4. (AB 1540) Effective January 1, 2010.