MedicaidAdministrativeMedium impact
20-911 Stay in Compliance with National and ICD-10 Coding Guidelines
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health now requires all claims to comply with National Correct Coding Guidelines and ICD-10-CM Official Guidelines for Coding and Reporting in Fresno, Kings and Madera counties. Claims with coding errors will be denied and must be resubmitted with corrected coding, though this does not affect existing authorizations or medical necessity determinations.
Action Required
Immediately: Billing team must review all claims for compliance with National Correct Coding Guidelines and ICD-10-CM Official Guidelines before submission. Train staff on proper coding practices using guidelines approved by AHA, AHIMA, CMS, and NCHS. Implement claim review process to prevent denials. Monitor provider portal at provider.healthnet.com for real-time claim status updates.