MedicaidAdministrativeHigh impact
26-280 Avoid Claim Denials: Critical Reminder for Long‑Term Care
Health Net·CA · Palliative Care, Geriatrics·Reimbursement
We identified it
Jun 20, 2026
Summary
Long-term care facilities must verify hospice providers are in-network with Medi-Cal managed care plans before transferring members, or risk claim denials and loss of reimbursement. Facilities must coordinate with the plan and obtain Single Case Agreements for out-of-network hospice transfers to avoid financial liability.
Action Required
Immediately: Long-term care facilities must establish verification process to confirm hospice provider network status with Community Health Plan of Imperial Valley before any member transfers. Billing team must coordinate with facilities to ensure required hospice documentation is submitted within 5 calendar days of hospice election date. Contact Provider Services to verify network status and obtain Single Case Agreements for out-of-network providers before transfer. Failure to follow these steps will result in claim denials and loss of room and board reimbursement.