All PlansReimbursementMedium impact
26-336 Behavioral Health Claims Reimbursement Update
Health Net·CA · Psychiatry·Reimbursement
Effective date
May 18, 2026
We identified it
Jun 20, 2026
Summary
Starting May 18, 2026, behavioral health claims reimbursement will be capped at the billed charge amount - payments cannot exceed what was billed. Providers should review their billing practices to ensure charges accurately reflect services rendered and align with standard reimbursement practices.
Action Required
Before May 18, 2026: Billing team must review all behavioral health billing practices to ensure billed charges accurately reflect services rendered and do not exceed reasonable amounts. Update billing procedures to verify charges align with Provider Participation Agreement requirements. Train staff that reimbursement will be limited to billed amounts starting this date.