MedicaidAdministrativeMedium impact
25-519 Help Ensure Medi-Cal Members Get the ECM and CS Services They Need
Health Net·CA · Family Medicine, Internal Medicine, General Practice +1 more·Prior Authorization
Effective date
Jul 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net California is implementing new closed-loop referral requirements for Medi-Cal Enhanced Care Management (ECM) and Community Supports (CS) services, requiring providers to use electronic communication methods and submit monthly data files by the 5th of each month. Providers must track referrals through completion and use specified platforms like the provider portal and Findhelp for making referrals.
Action Required
By July 1, 2025: Billing and clinical teams must implement closed-loop referral tracking for all ECM and CS referrals. Submit Return Transmission Files via SFTP by the 5th of each month with updated member information. Use provider portal or Findhelp platform for referrals instead of fax unless mutually agreed upon. Ensure all assigned members are included in monthly data submissions to avoid monitoring issues with DHCS.