MedicaidBilling CodesMedium impact
21-519m Reminder: Submit Claims with Correct Coding to Avoid Rejections
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net will now contest claims that contain invalid National Drug Code (NDC) and HCPCS code combinations, requiring providers to resubmit with correct coding. The insurer applies line-level edits to validate NDC codes, HCPCS codes, and their combinations before processing claims.
Action Required
Immediately: Billing team must verify NDC and HCPCS code combinations are valid before submitting claims to Health Net. Review current drug billing practices and access Health Net's Provider Library for NDC billing guidelines. Update billing workflow to double-check code combinations to avoid claim contests and resubmission delays.