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MedicaidReimbursementMedium impact

20-028 Prop 56 Rates Extended for SFY 2019-2021

Health Net·CA · Family Medicine, Internal Medicine, General Practice +2 more·Reimbursement
Effective date
Jul 1, 2019
We identified it
Jun 20, 2026
Days to comply

Summary

Proposition 56 supplemental payment rates for Medi-Cal physicians in Fresno, Kings, and Madera counties have been extended through December 31, 2021, maintaining the same rates as SFY 2018-2019. Providers must have a current W-9 on file and submit clean claims with qualifying CPT codes to receive supplemental payments within 90 days.

Action Required

Action needed
Immediately: Billing team must verify current W-9 forms are on file for all providers (update if not submitted in past 12 months). Ensure clean claims are submitted with qualifying CPT codes for Medi-Cal patients in Fresno, Kings, and Madera counties. Email updated W-9 forms to HNCA_W9_Submissions@Centene.com with subject 'Prop 56 W9' or fax to 1-833-794-0423. Supplemental payments will be made within 90 days of clean claim submission.

Affected Billing Codes

90791
90792
90863
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
99381
99382
99383
99384
99385
99391
99392
99393
99394
99395