MedicaidAdministrativeMedium impact
24-422m Know Your Rights and Protections as a Provider Serving American Indian Members
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net clarifies rights and billing protections for Indian Health Care Providers (IHCPs) serving American Indian members, establishing that IHCPs don't need contracts to receive reimbursement and must be paid at higher rates. This affects billing workflows for practices serving American Indian patients on Medi-Cal managed care plans.
Action Required
Immediately: Billing team should identify American Indian members in specified California counties (Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare, Tuolumne) and ensure no copayments, deductibles, or cost-sharing charges are applied. Update billing system to flag these members. Contact Health Net tribal liaison for claims payment assistance if needed for IHCP-related services.