Compensation of a person retained by a health care service plan to review claims for health care services shall not be based on either of the following:

(a)  A percentage of the amount by which a claim is reduced for payment.

Terms Used In California Health and Safety Code 1399.56

  • Person: means any person, individual, firm, association, organization, partnership, business trust, foundation, labor organization, corporation, limited liability company, public agency, or political subdivision of the state. See California Health and Safety Code 1345
  • plan: refers to health care service plans and specialized health care service plans. See California Health and Safety Code 1345

(b)  The number of claims or the cost of services for which the person has denied authorization or payment.

(Amended by Stats. 1995, Ch. 787, Sec. 2. Effective January 1, 1996.)

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