MedicaidCoverageMedium impact
20-801 Change to Financial Responsibility for Diagnostic Testing
Health Net·CA · Radiology, Sleep Medicine, Pulmonology·Prior Authorization
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Effective January 1, 2021, diagnostic testing performed at home (such as home sleep studies) will follow the same Division of Financial Responsibility (DOFR) as outpatient facility testing for Medi-Cal members in Fresno, Kings, and Madera counties. Participating physician groups (PPGs) with diagnostic testing risk will be financially responsible for both facility/technical and professional components of home diagnostic tests.
Action Required
Billing team should verify DOFR risk assignments for diagnostic testing and ensure proper billing workflows are in place for home diagnostic tests (including home sleep studies) to match outpatient facility procedures. Contact CalViva Health at 1-888-893-1569 with questions and use provider portal at provider.healthnet.com for eligibility verification.