MedicaidAdministrativeHigh impact
24-116 Balance Billing is Prohibited for Community Health Plan of Imperial Valley Members
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Community Health Plan of Imperial Valley has reinforced its prohibition on balance billing, meaning providers cannot charge members any fees beyond their copayment and coinsurance. When the plan is secondary to other insurance, providers cannot charge the member for the primary insurance's copay, coinsurance, or deductible as these are covered by the plan.
Action Required
Immediately: Billing team must review all Community Health Plan of Imperial Valley member accounts to ensure no balance billing is occurring. Update billing system to prevent charging members beyond copay/coinsurance. For members with other primary insurance, configure system to not charge primary insurance copays/deductibles to the member. Train front desk staff to verify member eligibility and coverage status using the provider portal before collecting payments.