MedicaidAdministrativeMedium impact
21-272 Report Third-Party Liability
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health is implementing new reporting requirements for third-party liability (TPL) tort cases affecting Medi-Cal members in Fresno, Kings, and Madera counties. Providers must prepare to submit TPL case information using a new DHCS-approved Excel template format with specific data elements including member information, claim details, diagnosis codes, CPT codes, and payment amounts.
Action Required
Before final APL release: Billing team should begin using the new DHCS-approved Excel template format for third-party liability reporting. Update data extraction systems to capture all required elements including member demographics, claim control numbers, diagnosis codes, CPT codes, amounts billed/paid, and reasonable values for capitated services. Contact CalViva Health at 888-calls-1569 for questions. Providers with proprietary TPL data extraction methods must adjust systems to accommodate new requirements.