Medicare AdvantageReimbursementMedium impact
24-186 A Change in Our Claims Pricing System May Improve the Accuracy of Your Payment
Health Net·CA·Reimbursement
Effective date
Apr 1, 2024
We identified it
Jun 20, 2026
Summary
Health Net has transitioned to a new claims pricing system that will change reimbursement for DME supplies with DME modifiers, aligning them with Medi-Cal fee schedules instead of Medicare rates starting in Q2 2024. Providers must now submit full 9-digit zip codes when filing Medicare claims to ensure proper fee schedule alignment.
Action Required
By Q2 2024: Billing team must update all Medicare claim submissions to include full 9-digit zip codes (including 4-digit extension) in billing system. Update DME billing procedures to expect lower reimbursement rates for supplies with DME modifiers as they will now align with Medi-Cal fee schedules instead of Medicare rates. Contact appropriate Health Net Provider Services Center if questions arise about specific claims.