Medicare AdvantageDocumentationMedium impact
23-379 Get Paid Faster: Send Medical Record Documentation if Requested for New Claims Review Policy for Medicare Claims
Health Net·CA·Provider News
Effective date
Apr 26, 2023
We identified it
Jun 20, 2026
Summary
HealthNet California has implemented a new claims prepayment review policy for Medicare claims that requires providers to submit medical record documentation when requested to support billed charges. This policy is designed to speed up payment processing by confirming documentation supports the services billed.
Action Required
Immediately: Billing team must respond promptly to any HealthNet California requests for medical record documentation to support Medicare claims. Establish workflow to quickly retrieve and submit requested medical records when notified during prepayment review. Failure to provide documentation may delay claim processing and payment.