CommercialReimbursementMedium impact
25-037 Progress Update to Resolve Underpaid Claims
Health Net·CA · Psychiatry·Reimbursement
Effective date
Feb 1, 2025
We identified it
Jun 20, 2026
Summary
HealthNet California is resolving an underpayment issue for behavioral health claims priced based on Medicare Allowable rates. Claims with POS code 02 (telehealth not in patient's home) have been incorrectly receiving facility rate reductions since September 1, 2024, while POS code 10 (telehealth in patient's home) claims are unaffected.
Action Required
Monitor behavioral health claims with POS code 02 for Employer Group HMO/PPO and Medi-Cal with dates of service after September 1, 2024. Contact Behavioral Health Provider Services at 844-966-0298 for underpayment adjustments until system fix is implemented in February 2025. Ensure POS code 10 is used for telehealth services when patient is in their home to avoid facility rate reduction.