MedicaidReimbursementMedium impact
22-1026 Inpatient Hospital Claims Affected Because New ICD-10 Codes Not Released
Health Net·CA · General Surgery, Orthopedics·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 adjust payments later when DHCS releases official pricing. Claims adjusted for payment will include a specific note on the explanation of payment identifying the 10/1/22 adjustment.
Action Required
Monitor explanation of payment documents for claims containing the note '10/1/22 – New ICD-10 code adjustment' to identify which inpatient claims received interim payments and may be subject to future rate adjustments. Contact Health Net Provider Services at 800-675-6110 within 60 days if questions arise about adjusted claims.