The DMHC regulates 98 health plans, of which 46 are full service plans. These plans have contracts with approximately 240 Risk Bearing Organizations (RBOs), which actually deliver or manage a large portion of the health care services to consumers. Plans provide about 50% of revenues to RBOs to provide health care.
The DMHC recognizes that proper claims payment is essential to California's health care delivery system. In 2004, the DMHC established the Provider Complaint Unit to ensure the prompt and accurate payment of claims to providers.
This section will give providers information on licensed plans, useful terms and answers to frequently asked questions about the managed care system.