The fires caused significant damage, destroying homes and businesses, and displacing both enrollees and healthcare providers. Following the Governor’s declaration of a state of emergency, Health and Safety Code section 1368.7 authorizes the Department of Managed Health Care (DMHC) to implement measures to mitigate the impact on affected enrollees and providers.
According to APL 25-005, Heritage Provider Network (HPN) has adopted the following rules for providers in Los Angeles and/or Ventura counties who were displaced by the fires with the following action:
- Extend the duration of existing prior authorizations by 180 calendar days so providers can focus on providing care to enrollees rather than having to re-request prior authorization for previously authorized services.
- Extend the minimum timeframes for contracted and non-contracted providers to submit claims under California Code of Regulations, title 28, section 1300.71(b) for both contracted and non-contracted providers to at least 365 days from the date of services.
- Extend the minimum time for the provider to dispute the overpayment from 30 working days to 180 calendar days.
- For a period of at least 6 months from the date of this APL (March 19, 2025), allow displaced providers to deliver care from appropriate alternative settings, such as mobile clinics or temporary locations.
How active disaster notices work
When a disaster declaration is issued (wildfire, public-health emergency, atmospheric river, etc.) HPN may publish provider flexibilities allowing modifications to authorization timelines, expanded telehealth use, member-cost-share waivers, and out-of-network coverage in impacted areas. Each notice indicates its applicable date range and geographic scope.
Reporting an active situation
Providers serving members in disaster-impacted areas may contact the Corporate Compliance line at 1-855-625-7894 or email corporatecompliance@heritagemed.com.