MedicaidReimbursementMedium impact
21-610 Understand Payment Requirements to Your Contracted Tribal FQHC
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
Health Net is implementing a new Alternative Payment Methodology (APM) for contracted Tribal FQHCs in San Diego. Participating Physician Groups must continue paying Medi-Cal rates to Tribal FQHCs but must also submit encounter data to Health Net so they can pay the rate difference directly to the FQHCs.
Action Required
Immediately: Billing teams with contracted Tribal FQHCs must ensure they continue paying the standard Medi-Cal rate for up to three visits per day (medical, mental health, or ambulatory services). Additionally, submit all encounter data to Health Net to enable them to pay the APM rate difference ($371.49 for dual beneficiaries, $519 for non-dual beneficiaries) directly to the Tribal FQHCs. Contact Health Net Medi-Cal Provider Services at 1-800-675-6110 with questions.