All PlansAdministrativeMedium impact
25-1234 PHCPN Manual Updated: New Billing Instructions for UB-04 and ADA Claim Forms
Health Net·CA · Oral & Maxillofacial Surgery·Reimbursement
We identified it
Jun 20, 2026
Summary
The PHCPN Operations Manual has been updated with new billing form requirements for California Department of Corrections and Rehabilitation (CDCR) patients. Hospitals and ambulatory surgery centers must use UB-04/CMS-1450 forms, while oral and maxillofacial surgeons must use the current ADA Dental Claim Form with specific CDCR patient identification requirements.
Action Required
Immediately: Billing team must ensure hospitals and ambulatory surgery centers use UB-04/CMS-1450 claim forms for all CDCR patient billing. Oral and maxillofacial surgeons must switch to the current ADA Dental Claim Form with proper CDCR patient identification entries. Access reference guides on the CorrectCare Integrated Health portal under the User Reference tab for detailed completion instructions.