MedicaidPrior AuthMedium impact
25-1081 Understanding Medi-Cal Non-Benefit Billing Codes: What Providers Need to Know
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health clarified that Medi-Cal 'non-benefit' billing codes may still be reimbursable when medically necessary and properly authorized. Providers must check prior authorization requirements for these codes and submit claims with authorization numbers to avoid denials.
Action Required
Immediately: Billing team must check CalViva Health's prior authorization requirements list for all 'non-benefit' codes before service delivery. Update workflow to obtain prior authorization when required and ensure authorization numbers are clearly indicated on all claim submissions. For denied claims involving non-benefit codes, initiate dispute resolution through CalViva Health (888-893-1569) or behavioral health line (844-966-0298). Review updated provider operations manuals in the Provider Library portal.