Traditional MedicareReimbursementMedium impact
24-188 A Change in Our Claims Pricing System May Improve the Accuracy of Your Payment
Health Net·CA·Reimbursement
Effective date
Jun 30, 2024
We identified it
Jun 20, 2026
Summary
Health Net Community Health Plan of Imperial Valley has implemented a new claims pricing system that corrects DME supply claims to align with Medi-Cal fee schedule instead of Medicare rates, potentially reducing future reimbursements. Providers must now include full 9-digit zip codes on Medicare claims for proper fee schedule alignment.
Action Required
Immediately: Update billing system to require full 9-digit zip code (including 4-digit extender) for all Medicare claims submissions. Train billing staff on DME supply claims changes - expect lower reimbursement rates for DME supplies with modifiers as they now follow Medi-Cal fee schedule. Contact CHPIV at 833-236-4141 with questions about specific claims.