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Preventive Care Connections #4: Supporting Positive Billing Experiences
Effective date
Not stated in the notice
Identified
Oct 23, 2026
Summary
L.A. Care Health Plan issued a reminder (not a new policy change) reinforcing existing balance-billing protections and member cost-sharing compliance requirements. The guidance clarifies provider billing responsibilities, prohibits balance billing for denied or delayed claims, and outlines correction procedures if members are charged in error. This is an informational reinforcement of applicable law and existing contractual obligations, not a substantive policy modification.
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What to do
Action · 11 steps
01Billing team should review this reminder and confirm current compliance with existing balance-billing prohibitions.
02Verify that claims are billed to L.A.
03Care or the appropriate responsible payer, not to members;.
04Confirm that members are not billed solely because claims were denied, reduced, delayed, or underpaid.
05Ensure only contractually permitted cost-sharing is collected.
06Verify eligibility and benefits before requesting member payment.
07Use dispute and appeal processes for payment disagreements rather than balance billing.
08Establish a procedure to immediately stop collection activity, correct accounts, refund improper charges, and notify members if billing errors are identified.
09Share this reminder with front-office staff, billing personnel, vendors, and member-facing staff.
10No future deadline is stated; this reflects ongoing obligations under existing L.A.
11Care contracts and California balance-billing law.
Original notice
Preventive Care Connections #4: Supporting Positive Billing Experiences
lacare.org · Always check the source before changing claims.