CalOPTIMA

Defendant CalOptima is a county organized health system (COHS) providing services to Medi-Cal beneficiaries through contracts with various health care providers. Under its prior authorization policy, CalOptima requires long-term care providers to submit treatment authorization requests (TAR’s) within 21 days of the patient’s admission. This case arose out of six TAR’s submitted by plaintiff Life Care Centers of America, doing business as La Habra Convalescent Hospital (Life Care), to defendant CalOptima seeking payment for patients admitted to Life Care’s facility. CalOptima refused to pay the full amount requested because Life Care failed to submit the TAR’s within the 21-day deadline. Life Care filed a petition for peremptory writ of mandate, requesting the trial court to require CalOptima to make full payment on each of the six TAR’s. The trial court denied CalOptima’s request for judgment, granted Life Care’s writ petition and awarded Life Care attorney fees. CalOptima appeals each of these rulings.

We conclude Life Care failed to prove that CalOptima’s enforcement of its 21-day submission deadline was arbitrary, capricious, unsupported by substantial evidence, or…