Traditional MedicareReimbursementMedium impact
24-187 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/CalViva Health has implemented a new claims pricing system that corrects DME claims reimbursement from Medicare fee schedule to proper Medi-Cal rates, potentially reducing future payments. Providers must also include full 9-digit zip codes on Medicare claims for proper fee schedule alignment.
Action Required
By Q2 2024: Billing team must update claim submission process to include full 9-digit zip codes (including 4-digit extender) for all Medicare claims. Review and expect reduced reimbursement for DME supplies billed with DME modifiers as they now align with Medi-Cal fee schedule instead of Medicare rates. Contact CalViva Health at 888-893-1569 with questions.