MedicaidAdministrativeHigh impact
26-278 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 Health Net before transferring Medi-Cal members to avoid claim denials. Unauthorized transfers to out-of-network hospice providers will result in denial of both hospice services and LTC room and board reimbursement unless a Single Case Agreement is approved.
Action Required
Immediately: Before transferring any Medi-Cal member to hospice care, LTC facilities must: 1) Contact Health Net Provider Services to verify hospice provider network status, 2) Submit all required hospice documentation within 5 calendar days of hospice election date, 3) Notify Health Net before any member transfer to hospice, 4) For out-of-network requests, obtain Health Net approval for Single Case Agreement before transfer. Failure to follow these steps will result in denial of hospice services payment and loss of LTC room and board reimbursement.