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Preventive Care Connections #4: Supporting Positive Billing Experiences
Effective date
Not stated in the notice
Identified
Oct 10, 2026
Summary
L.A. Care Health Plan issued a reminder to contracted providers reinforcing balance-billing protections and proper billing practices. Providers must bill the plan (not members) for covered services, collect only authorized cost-sharing, verify eligibility and benefits before requesting member payment, and promptly correct and refund any improper charges. This is a compliance reminder with no new policy changes, effective dates, or deadline.
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What to do
Action · 11 steps
01Billing team and front-office staff should review and reinforce current balance-billing compliance practices.
02Ensure all claims for covered services are billed to L.A.
03Care or the appropriate responsible payer, not to members;.
04Do not bill members when claims are denied, reduced, delayed, or underpaid.
05Verify eligibility, benefits, and authorization requirements before requesting member payment.
06Collect only authorized cost-sharing amounts per the member's benefit plan and applicable law.
07Use provider dispute/reconsideration/appeal processes for payment disagreements.
08Establish a process to identify, stop collection on, correct, and refund any improper charges identified in member accounts.
09Notify members when charges are corrected with updated account information.
10Share this guidance with all personnel who communicate with members about payment, including front-office staff, billing personnel, and outside vendors.
11No future deadline is stated; compliance with these practices is ongoing.
Original notice
Preventive Care Connections #4: Supporting Positive Billing Experiences
lacare.org no longer serves this document. We saved a copy on Nov 6, 2026.