MedicaidAdministrativeHigh impact
26-709 Avoid Medi-Cal Claim Denials: Verify Individual Provider Participation Status
Health Net·CA·Provider News
We identified it
Jun 20, 2026
Summary
Health Net Community Health Plan of Imperial Valley now requires individual provider participation verification for all Medi-Cal claims, even when billed under contracted groups. Claims will be denied as non-participating if rendering providers are not properly credentialed with the Plan, enrolled with DHCS, or included on group rosters at time of service.
Action Required
Immediately: Billing team must verify all rendering providers are properly credentialed with Health Net, enrolled with DHCS, and included on current group rosters before submitting Medi-Cal claims. Log into provider portal monthly to review Active Physicians Listing under Provider Reports and submit roster updates through established Plan processes. Failure to maintain current provider participation status will result in claim denials that cannot be reprocessed.