[California] June 2026 Provider Newsletter

REQUIREMENTS: 1. By June 1, 2026 (Immediate): Billing team must update provider directories and internal documentation to reflect Direct HMO rebrand to Independent FFS Physicians for commercial plans. Ensure all internal references and portal systems reflect new name. 2. By July 15, 2026: Implement weekly authorization and denial log submission process for all HMO risk providers. Billing team must establish automated or manual weekly reporting workflow in billing system to track denials and authorizations. Failure to submit logs may result in claims accuracy issues and compliance violations. 3. By mid-July 2026: Providers must prepare to utilize online peer-to-peer conversation management tool for physical health discussions. Train staff on new digital platform to replace phone-based peer reviews. 4. By July 17, 2026: Billing team must verify that all charges and units billed on professional claims are accurate in billing system. Audit claims for proper documentation of services and units rendered. Implement claims accuracy validation checks before submission for commercial, Medicare Advantage, and Medicaid plans. 5. By July 1, 2026: Review parenteral nutrition codes and update prior authorization requirements accordingly for Medicare Advantage plans. Obtain prior authorization before submitting parenteral nutrition claims. 6. By September 1, 2026: Update prior authorization requirements for all identified services and pharmacy claims for Medicare Advantage and Medicaid plans. Billing team must implement these changes in authorization workflow and alert providers of new requirements. 7. By August 18, 2026: Review updated Medical Policies and Clinical Utilization Management Guidelines for Medicaid plans and ensure compliance with new criteria. 8. By June 1, 2026 (Medicare Advantage) and ongoing: Implement clinical criteria updates for Medicare Advantage effective June 1, 2026, and review September 1, 2026 Medicaid clinical criteria updates.