26-849 Provider Communications Posted Online and Operations Manual Updates for June 2026

REQUIREMENTS: 1. By June 12, 2026 (IMMEDIATE): Billing team must verify that all claims include rendering provider participation status documentation. Update billing system validation rules to confirm rendering providers are credentialed, enrolled with DHCS, and listed on provider roster at time of service. This applies across all claim submissions. Claims lacking this verification will be denied per new participation reimbursement policy (effective 6/12/26). 2. By June 9, 2026 (URGENT - RETROACTIVE): Provider Relations and Contracting teams must update PPG and downstream hospital termination notification procedures. Implement expanded notification requirements with earlier reporting timelines per mandatory notification policy. Ensure compliance team understands new reporting obligations related to DHCS All Plan Letter 25-019. Non-compliance may delay regulatory approval. 3. By June 15, 2026: Billing and Clinical Documentation teams must access and distribute updated HEDIS Resource Page tip sheets to all physicians, practitioners, and behavioral health providers. Review current measurement descriptions, eligible populations, exclusions, and coding requirements. Integrate best practice guidance into claim submission workflows. 4. By June 26, 2026: All providers must review updated appointment wait time standards in the 'Enhancing Patient Experience Through Timely Access' flyer (updated from February 2026 version). Ensure scheduling practices align with regulatory requirements. 5. By June 29, 2026: Clinical and Billing teams must review May 2026 clinical policy updates (26-817m). Verify that all services submitted for reimbursement are medically necessary and comply with updated medical policies. Remember that member benefits, legal and regulatory mandates take precedence over policy content. 6. By June 30, 2026: Behavioral Health billing team must implement new dyadic services billing requirements. Review 26-804m guidance on proper billing for services that include parent/caregiver support. Document that services directly support the child's needs to avoid denials and payment delays. 7. By June 25, 2026: Hospital and PPG billing teams must implement new financial responsibility framework for major organ transplant services. Billing staff must reference Division of Financial Responsibility (DOFR) assignments and apply correct financial responsibility based on time since discharge for post-transplant services.