MedicaidReimbursementMedium impact
26-337 Behavioral Health Claims Reimbursement Update
Health Net·CA · Psychiatry·Reimbursement
Effective date
May 18, 2026
We identified it
Jun 20, 2026
Summary
Beginning May 18, 2026, behavioral health claims will not be reimbursed for amounts exceeding the billed charges submitted on claims. This change affects all behavioral health claims processed on or after this date regardless of service date.
Action Required
Before May 18, 2026: Behavioral health billing team must review and update billing practices to ensure billed charges accurately reflect services rendered and align with contracted rates. Update billing system validation to prevent submitting charges that exceed appropriate reimbursement amounts. Review Provider Participation Agreement requirements for charge submission guidelines.