MedicaidBilling CodesMedium impact
21-517m 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 Medi-Cal claims with invalid National Drug Code (NDC) and HCPCS code combinations, requiring corrected billing before processing. This applies to providers in 9 California counties and affects physicians, hospitals, and ancillary providers submitting drug-related claims.
Action Required
Immediately: Billing team must verify NDC and HCPCS code combinations are valid before submitting Medi-Cal claims. Update billing system validation rules to check NDC/HCPCS compatibility. Reference Health Net's 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 corrected rebilling.