MedicaidAdministrativeMedium impact
21-417 New Reporting Requirements for Third-Party Liability
Health Net·CA·Prior Authorization
Effective date
Aug 8, 2021
We identified it
Jun 20, 2026
Summary
CalViva Health (Medi-Cal) has implemented new standardized reporting requirements for Third-Party Liability (TPL) claims, requiring providers to submit detailed claims data using a DHCS-approved Excel worksheet via secure file transfer when requested. Providers must respond within 30 calendar days when Health Net requests TPL information for members with potential third-party liability cases.
Action Required
When requested by Health Net: Billing team must complete the DHCS-approved Excel worksheet with all required TPL data elements including member information, claim details, diagnosis codes, CPT codes, and payment amounts. Submit completed worksheet and supporting documents within 30 calendar days of Health Net's request via the specified process to ensure DHCS compliance.