MedicaidReimbursementMedium impact
25-543 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/CalViva Health has changed how they pay Targeted Rate Increase (TRI) fee-for-service payments for Medi-Cal claims. Starting May 31, 2025, these payments will come as new day claims instead of retroactive adjustments to existing claims.
Action Required
Effective May 31, 2025: Billing team should monitor for new day claims from Health Net/CalViva Health representing TRI fee-for-service payments instead of retroactive adjustments. Update accounts receivable processes to recognize these as supplemental payments for previously submitted claims. Access the Health Net provider portal and review TRI resources at Health Net webpage > Providers > 2024 DHCS Targeted Rate Increase for Select Medi-Cal Services.