All PlansAdministrativeHigh impact
20-912 Stay in Compliance with National and ICD-10 Coding Guidelines
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net will now edit all submitted claims to ensure compliance with National Correct Coding Guidelines and ICD-10-CM Official Guidelines. Claims that don't meet coding standards will be denied and require resubmission with corrected coding, but this editing won't affect existing authorizations or medical necessity determinations.
Action Required
Immediately: Billing team must review all claim submissions to ensure strict compliance with National Correct Coding Guidelines and ICD-10-CM Official Guidelines before submission. Update quality assurance processes to catch coding errors before claims are sent. Train staff on proper ICD-10 coding standards from AHA, AHIMA, CMS, and NCHS. Non-compliant claims will be denied and require resubmission.