MedicaidReimbursementMedium impact
25-544 TRI Fee-for-Service Payments Are Now Applied to New Claims
Health Net·CA·Prior Authorization
Effective date
May 31, 2025
We identified it
Jun 20, 2026
Summary
Health Net/Community Health Plan of Imperial Valley switched from retroactive adjustments to new day claims for Targeted Rate Increase (TRI) fee-for-service payments effective May 31, 2025. Instead of receiving retroactive payment adjustments for Medi-Cal rate increases, providers will now receive separate new claims for these additional payments.
Action Required
Effective May 31, 2025: Billing team should monitor for new day claims from Health Net/Community Health Plan of Imperial Valley for TRI payments instead of expecting retroactive adjustments. Update accounts receivable processes to recognize these new claims as additional payments for previously submitted Medi-Cal services. Contact plan at 833-236-4141 for questions or 844-966-0298 for behavioral health providers.