Medicare AdvantageAdministrativeHigh impact
26-847 Provider Communications Posted Online and Operations Manual Updates for June 2026
Health Net·CA · Bariatric Surgery, Psychiatry, Transplant Surgery +1 more·Reimbursement
Effective date
Jun 9, 2026
We identified it
Jul 8, 2026
Summary
Health Net released a comprehensive June 2026 policy update containing multiple provider communications and operations manual changes affecting billing, credentialing, and claims processing. Key changes include new Medi-Cal participation requirements for reimbursement (effective 6/12/26), updated transitions of care (TRC) and emergency department follow-up (FMC) documentation requirements (6/29/26), mandatory notification requirements for provider terminations, and new financial responsibility guidance for transplant services. Billing teams must immediately review affected plan types and implement requirement changes to avoid claim denials.
Action Required
REQUIREMENTS:
1. By June 12, 2026: Billing team must implement verification that ALL rendering providers on claims are credentialed, enrolled with DHCS, and listed on provider roster at time of service for Medi-Cal claims. Update billing system validation rules to deny or hold claims that fail this verification. Consequences: Claims will be denied if these Medi-Cal participation requirements are not met (Document: Medi-Cal Participation Requirements for Reimbursement, effective 6/12/26).
2. By June 29, 2026: Billing and clinical teams must obtain and implement the new TRC (Transitions of Care) and FMC (Follow-Up After Emergency Department Visit) standardized checklist for Medicare Advantage plans. Ensure all required documentation elements and timelines are captured before billing these codes. Update EMR/billing templates to reflect required documentation. Consequences: Non-compliance will result in missed care gap reporting and potential claim denials (Reference: 26-758m).
3. By June 30, 2026: Behavioral health billing team must review and implement correct billing methodology for dyadic services under Medi-Cal. Ensure claims reflect that services directly support the child's needs, with parent/caregiver support as secondary. Update claim form instructions and provider education. Consequences: Dyadic service claims billed incorrectly will be denied (Reference: 26-802m).
4. By June 25, 2026: Billing team managing transplant cases for Medi-Cal must review new Financial Risk Responsibilities document and implement Division of Financial Responsibility (DOFR) guidelines for major organ transplants. Ensure post-transplant service billing aligns with time-since-discharge guidance. Consequences: Claims may be denied if financial responsibility assignment is incorrect (Document: Financial Risk Responsibilities under Benefits > Transplant).
5. Immediately: All billing staff must update provider network termination procedures per mandatory notification requirements (effective 6/9/26). Ensure earlier reporting timelines and expanded notification requirements for PPG and hospital terminations are followed to meet DHCS compliance (Reference: DHCS All Plan Letter 25-019).
6. By June 26, 2026: Billing team must update hospice care claims processing procedures per updated Medicare guidance. Review current hospice billing protocols and adjust for new guidance (Document: Hospice Care under Benefits).
7. Reference new Bariatric Surgery Performance Centers list (effective 6/24/26) for any prior authorization or facility-based billing requirements.