All PlansAdministrativeMedium impact
23-811 Claims Submission Reminder: CCHS Submission Criteria is Required
Health Net·CA·Pharmacy
We identified it
Jun 20, 2026
Summary
Healthcare providers treating California Department of Corrections and Rehabilitation (CDCR) patients must use separate CMS-1500 claims for each place of service and cannot use 40+ specific invalid POS codes including pharmacy, telehealth at home, assisted living, and various specialty facilities. Claims with multiple POS codes on one form or invalid POS codes will be rejected and returned.
Action Required
Immediately: Billing team must update procedures for CDCR patient claims to submit separate CMS-1500 forms for each place of service location. Remove all invalid POS codes (01, 03-08, 10, 12-18, 25-30, 34-40, 43-48, 51-60, 63-64, 66-71, 73-80, 82-99) from billing system options for CDCR patients. Verify patient names and CDCR ID numbers using the CDCR Inmate Locator web tool. Claims with multiple POS codes or invalid codes will be rejected.