MedicaidAdministrativeMedium impact
24-421m Know Your Rights and Protections as a Provider Serving American Indian Members
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health has clarified rights and protections for providers serving American Indian members under Medi-Cal managed care, including special contracting, credentialing, and reimbursement rules. Indian Health Care Providers (IHCPs) can receive reimbursement without contracting with the plan, and American Indian members can access IHCP services without prior authorization or referrals.
Action Required
Immediately: Billing team should review current American Indian member claims processes to ensure compliance with special reimbursement rules. Update billing workflows to recognize that IHCPs do not require prior authorization for American Indian members and can be reimbursed without plan contracts. Contact CalViva Health tribal liaison at 888-893-1569 for claims assistance if serving American Indian members.