MedicaidAdministrativeMedium impact
26-279 Avoid Claim Denials: Critical Reminder for Long‑Term Care
Health Net·CA · Palliative Care·Reimbursement
We identified it
Jun 20, 2026
Summary
Long-term care facilities must verify hospice providers are in-network with CalViva Health before transfers, coordinate with the Plan, and submit required documentation within 5 days of hospice election. Unauthorized transfers to out-of-network hospice providers will result in claim denials and loss of both hospice and room/board reimbursement.
Action Required
Immediately: Long-term care facilities must establish new workflow to verify hospice network status with CalViva Health before any member transfers. Contact CalViva Health Provider Services to confirm hospice provider contracts before initiating transfers. Submit all required hospice documentation within 5 calendar days of hospice election date. Notify the Plan before transferring any member to hospice care. Failure to follow these steps will result in claim denials and loss of room and board reimbursement.