MedicaidAdministrativeHigh impact
22-464 Respond to Requests for Itemized Bills to Ensure Timely Payment
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Hospitals must now respond promptly to requests for itemized bills supporting inpatient claims when notified by fax, phone, or mail to avoid payment delays. The plan will conduct pre-payment reviews to ensure only correct charges are reimbursed according to CMS guidelines.
Action Required
Immediately: Hospital billing teams must establish process to respond promptly to all requests for itemized bills supporting inpatient claims received by fax, phone, or mail. Ensure itemized bills comply with Centers for Medicare & Medicaid Services Provider Reimbursement Manual, Uniform Billing Editor guidelines, and Revenue Code Definition requirements. Failure to respond timely will cause payment delays.