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20-552 Earn Incentives through the Prop 56 VBP Program
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Health Net's Prop 56 Value-Based Payment (VBP) program pays add-on payments to Medi-Cal providers in Fresno, Kings and Madera counties for meeting specific measures in prenatal and postpartum care, early childhood care, chronic disease management and behavioral health integration. Payments apply to services performed on or after July 1, 2019, when submitted as a clean claim or encounter within one year from the date of service with a qualifying CPT and/or ICD-10 code. Payment amounts are higher for at-risk members, for example $70 for a prenatal care visit and $105 for an at-risk prenatal care visit, and $80 for diabetes care and $120 for at-risk diabetes care.
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What to do
Action · 8 steps
01Make sure the individual (Type 1) NPI is on each claim or encounter in the rendering or ordering provider field, or in the prescribing provider field if the rendering or ordering field is blank, or in the billing provider field if those fields are blank, because payment cannot be made without it.
02Submit a current W-9 form that includes the rendering physician's current address, individual TIN and individual (Type 1) NPI, along with the contact information sheet and a list of providers with the same TIN and NPI.
03Email it to HNCA_W9_Submissions@CENTENE.COM with 'Prop 56 W9' in the subject line, or fax it to 1-833-794-0423 with a cover sheet marked 'Prop 56 W9' and 'PROTECTED HEALTH INFORMATION'.
04Submit a clean claim or encounter within one year from the date of service with a qualifying CPT and/or ICD-10 code, and if contracting through a participating physician group, make sure the group submits encounters timely and accurately.
05Services performed from July 1, 2019 through December 31, 2019 were under review, and the next review covers services from January 1, 2020 through June 30, 2020.
06For encounters submitted to the PPG, submit a payment dispute by email to HNCA_EncDisputes@healthnet.com with 'Prop 56 VBP Grievance' in the subject line, including the reason for the dispute, impacted TINs and NPIs, and an Excel spreadsheet with patient name, date of birth, CIN, dates of service, CPTs with any modifiers, and patient control number or PPG claim number.
07For claims submitted to the medical plan, follow the dispute resolution section of the Medi-Cal Provider Manual.
08For questions about W-9 status, Prop 56 payments or remittance advice, contact CalViva Health at 1-888-893-1569.
Codes mentioned
907159938199385993919939599461G0438G04398365599188D12069940699407G8431G85109940899409G0396G0397G0442G0443H0049H0050O09Z34Z39.2Z00.00Z00.01Z00.110Z00.111Z00.121Z00.129Z00.5Z00.8Z02.0Z02.6Z02.71Z02.82Z76.1Z76.2I10J45.20J45.21J45.22J45.50J45.51J45.52J45.30J45.31J45.32J45.901J45.902J45.909J45.40J45.41J45.42J45.990J45.991J45.998F32.0F32.4F32.9F33.0F33.3F33.41F33.9
Original notice
20-552 Earn Incentives through the Prop 56 VBP Program
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
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Related policy hubs
Health Net policiesCA policy changesPediatricsOB-GYNFamily MedicineInternal MedicineEndocrinologyPulmonologyPsychiatryDentistryCardiologyCode 90715Code 99381Code 99385Code 99391Code 99395Code 99461Code G0438Code G0439Code 83655Code 99188Code D1206Code 99406Code 99407Code G8431Code G8510Code 99408Code 99409Code G0396Code G0397Code G0442Code G0443Code H0049Code H0050Code O09Code Z34Code Z39.2Code Z00.00Code Z00.01Code Z00.110Code Z00.111Code Z00.121Code Z00.129Code Z00.5Code Z00.8Code Z02.0Code Z02.6Code Z02.71Code Z02.82Code Z76.1Code Z76.2Code I10Code J45.20Code J45.21Code J45.22Code J45.50Code J45.51Code J45.52Code J45.30Code J45.31Code J45.32Code J45.901Code J45.902Code J45.909Code J45.40Code J45.41Code J45.42Code J45.990Code J45.991Code J45.998Code F32.0Code F32.4Code F32.9Code F33.0Code F33.3Code F33.41Code F33.9