MedicaidAdministrativeHigh impact
26-707 Avoid Medi-Cal Claim Denials: Verify Individual Provider Participation Status
Health Net·CA·Provider News
We identified it
Jun 20, 2026
Summary
Health Net now requires individual provider participation verification for all Medi-Cal claims, even when billed under contracted groups. Claims will be denied if rendering providers are not enrolled with DHCS, credentialed with Health Net, or included on the group's provider roster at time of service.
Action Required
Immediately: Billing team must verify all rendering providers are enrolled with DHCS, credentialed with Health Net, and included on group provider rosters before submitting Medi-Cal claims. Monthly review Active Physicians Listing in Health Net provider portal under Provider Reports to confirm roster accuracy. Submit roster updates, corrections and terminations through established Health Net processes. Claims will be denied as non-participating if provider requirements are not met at time of service and will not be reprocessed.