MedicaidReimbursementHigh impact
23-792 Prohibited Balance Billing for Medi-Cal Members
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
CalViva Health reinforces that providers cannot balance bill Medi-Cal members for any covered services beyond required copayments, coinsurance, or share-of-cost amounts. When Medi-Cal is secondary to other coverage, providers must not charge members for copayments, coinsurance, or deductibles as these are covered by the Medi-Cal plan.
Action Required
Immediately: Billing team must review all Medi-Cal member accounts to ensure no balance billing is occurring for covered services. Stop charging copayments, coinsurance, or deductibles when Medi-Cal is secondary coverage. Update billing system rules to prevent balance billing of Medi-Cal members. Train staff on proper billing procedures for members with Medi-Cal as primary or secondary coverage. Non-compliance may result in violations of Provider Participation Agreement.