MedicaidAdministrativeMedium impact
20-928 Notice of Correction for 20-801, Change to Financial Responsibility for Diagnostic Testing
Health Net·CA · Sleep Medicine, Pulmonology·Prior Authorization
We identified it
Jun 20, 2026
Summary
This correction clarifies that home sleep studies follow the same Division of Financial Responsibility rules as outpatient facility diagnostic testing for Medi-Cal in Fresno, Kings and Madera counties. Participating physician groups with diagnostic testing risk are financially responsible for both technical and professional components of home sleep studies.
Action Required
Immediately: Billing team must verify Division of Financial Responsibility contracts to determine if practice has diagnostic testing risk for outpatient facilities. If yes, update billing workflows to handle financial responsibility for home sleep studies (both technical and professional components) for Medi-Cal patients in Fresno, Kings and Madera counties. Contact CalViva Health at 1-888-893-1569 with questions.