MedicaidBilling CodesHigh impact
21-518m Reminder: Submit Claims with Correct Coding to Avoid Rejections
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health will now contest Medi-Cal claims that contain invalid NDC codes, HCPCS codes, or invalid NDC/HCPCS code combinations, requiring providers to submit corrected billing. This applies to providers in Fresno, Kings and Madera counties.
Action Required
Immediately: Billing team must verify all NDC and HCPCS code combinations are valid before submitting Medi-Cal claims to CalViva Health. Review current claims processes to ensure NDC codes match appropriate HCPCS codes. Access the Provider Library for NDC billing guidelines under Medi-Cal > Provider Manual > Claims and Provider Reimbursement > Billing and Submission > National Drug Codes. Invalid code combinations will result in claim contests requiring resubmission.