MedicaidAdministrativeMedium impact
24-423m Know Your Rights and Protections as a Provider Serving American Indian Members
Health Net·CA·Prior Authorization
Effective date
Feb 8, 2024
We identified it
Jun 20, 2026
Summary
New policy clarifies rights and protections for Indian Health Care Providers (IHCPs) serving American Indian members under Medi-Cal managed care. IHCPs can receive reimbursement without contracting with plans, must be paid at higher rates (Medicaid fee-for-service or IHS encounter rates), and American Indian members can access IHCP services without prior authorization or referrals.
Action Required
Immediately: Billing team must update processes to ensure Indian Health Care Providers are reimbursed without requiring contracts and at appropriate rates (Medicaid fee-for-service or IHS encounter rates, whichever is higher). Update system to waive prior authorization requirements for American Indian members accessing IHCP services. Contact tribal liaison at 833-236-4141 for claims and payment assistance when processing IHCP claims.