CommercialAdministrativeMedium impact
23-409 New Durable Medical Equipment Billing Audit Program Ensures Correct Claims Payment
Health Net·CA · Orthopedics, PM&R (Physical Medicine & Rehab)·Prior Authorization
Effective date
Jul 15, 2023
We identified it
Jun 20, 2026
Summary
Health Net implemented a new post-payment audit program for durable medical equipment claims effective July 15, 2023, using vendor Performant to conduct monthly audits. Providers selected for audit will receive written notice and must submit medical records to verify claims were billed correctly with proper documentation.
Action Required
Ongoing: Ensure all DME claims have complete supporting documentation and are billed accurately as they may be selected for post-payment audit by Performant. Billing team must respond promptly to any written audit requests with required medical records. Monitor for audit notices and establish process to provide documentation within requested timeframes to avoid potential claim recoupments.