MedicaidAdministrativeHigh impact
26-708 Avoid Medi-Cal Claim Denials: Verify Individual Provider Participation Status
Health Net·CA·Provider News
We identified it
Jun 20, 2026
Summary
Health Net/CalViva Health will now deny Medi-Cal claims if individual rendering providers don't meet all participation requirements, even when billing under a contracted group. Claims are processed based on each provider's individual credentialing, DHCS enrollment, and roster status rather than the group contract.
Action Required
Immediately: Billing team must verify all rendering providers are properly credentialed with Health Net, enrolled with DHCS, and included on group provider rosters before submitting Medi-Cal claims. Login to provider portal monthly to review Active Physicians Listing under Provider Reports and submit roster updates through established processes. Claims will be denied as non-participating if any requirement is missing, and will NOT be reprocessed retroactively.