MedicaidAdministrativeMedium impact
23-674m Get Paid Faster: Bill Correctly When Members Have Other Health Coverage
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
This policy clarifies billing procedures when Medi-Cal members have other health coverage (OHC). Providers must bill the primary insurance first, then bill Medi-Cal as secondary payer with proper documentation including EOBs or denial letters.
Action Required
Immediately: Billing team must ensure all Medi-Cal claims with other health coverage are billed to primary insurance first. Attach EOB or denial letter from primary payer when billing Medi-Cal as secondary. Do not reduce charge amounts due to OHC payments. Use only Medi-Cal-approved HCPCS and CPT codes when billing secondary claims.