MedicaidReimbursementLow impact
21-612 Understand Your Payment Reimbursement Process
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
Health Net updated payment procedures for Tribal FQHC providers in San Diego County, clarifying the Alternate Payment Methodology (APM) reimbursement process. Providers contracted through PPGs receive Medi-Cal rates initially, then Health Net pays the difference to reach APM rates ($371.49 for dual-eligible, $519 for non-dual beneficiaries).
Action Required
Tribal FQHC providers in San Diego County: Verify you are receiving full APM payments by contacting your PPG (if contracted through PPG) or Health Net directly at 800-675-6110 (if directly contracted) to ensure encounter data submission and proper reimbursement. Monitor that you receive both initial Medi-Cal payment and subsequent APM difference payment.