26-850 Provider Communications Posted Online and Operations Manual Updates for June 2026

REQUIREMENTS: By 6/9/26 (IMMEDIATE - already effective): Billing and contracting teams must review and implement the updated Mandatory Notification Requirements for PPG Downstream Hospital Terminations. When any PPG or hospital network provider terminates, ensure earlier reporting to CalViva Health with all required information per DHCS All Plan Letter 25-019 to support timely regulatory review. Failure to comply with expanded notification requirements may result in regulatory non-compliance. By 6/12/26 (IMMEDIATE - already effective): Billing team must verify and update all claim submission processes to ensure rendering providers meet Medi-Cal participation requirements at time of service: (1) Rendering provider must be credentialed with CalViva Health, (2) Rendering provider must be enrolled with DHCS, and (3) Rendering provider must be listed on the active provider roster at time of service. Update billing system validation rules to check provider participation status against roster before claims are submitted. Add internal audit process to verify these requirements before billing. Claims submitted without meeting these requirements will be denied for lack of provider participation. By 6/25/26: PPG and hospital billing staff must review new Financial Risk Responsibilities document (under Benefits > Transplant section of operations manual) to understand financial responsibility assignments for major organ transplant services under Division of Financial Responsibility (DOFR). Update internal billing guidance for post-transplant services based on time since discharge to ensure correct reimbursement assignment. Immediate: All behavioral health providers must review 26-803m guidance on dyadic services billing requirements. Billing staff must ensure dyadic service claims include documentation that services directly support the child's needs, not solely parent/caregiver support. Incorrect billing of dyadic services may result in denials and payment delays. Immediate: Physicians/practitioners, PPGs, hospitals, and ancillary providers in Fresno, Kings, and Madera counties should access the Provider Library to review all June 2026 communications and operations manual updates. Reference new access to care standards (26-737m), HEDIS resource tips (26-704m), appointment wait time standards (26-689m), and May 2026 clinical policy changes (26-816m) to ensure compliance with current medical necessity and billing guidelines.