MedicaidReimbursementMedium impact
22-1027 Inpatient Hospital Claims Affected Because New ICD-10 Codes Not Released
Health Net·CA·Reimbursement
Effective date
Oct 1, 2022
We identified it
Jun 20, 2026
Summary
Health Net will process inpatient hospital claims with new ICD-10 codes using available rates and make payment adjustments later when DHCS releases official pricing. Claims adjusted for payment will include a specific note on the explanation of payment.
Action Required
Immediately: Monitor explanation of payment documents for inpatient claims with new ICD-10 codes. Look for the note '10/1/22 – New ICD-10 code adjustment' which indicates the claim was processed with temporary rates and may be adjusted later. Contact CalViva Health at 888-893-1569 with questions about payment adjustments.