Traditional MedicareReimbursementMedium impact
25-973 Change to Coordinating Medi-Cal Benefits When Medicare is Primary
Health Net·CA·Reimbursement
Effective date
Nov 1, 2025
We identified it
Jun 20, 2026
Summary
Starting November 1, 2025, Health Net will no longer use Medicare's Explanation of Benefits (EOMB) rates to coordinate Medi-Cal benefits when Medicare is primary. Instead, providers' contract rates will be used to determine Medi-Cal reimbursement amounts when no Medi-Cal rate is available.
Action Required
Before November 1, 2025: Billing team should review current Health Net Medi-Cal contracts to understand default pricing rates that will be applied for coordination of benefits. Update billing system expectations for dual Medicare/Medi-Cal claims reimbursement calculations. Contact Health Net Provider Services at 800-675-6001 with questions about contract rates.