← Back to list
Provider Payment Reductions and Billing Guidelines
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
L.A. Care Health Plan implemented a 1% automatic payment reduction on claims per state mandate, with exemptions for certain services including family planning and services under the new TRI Fee Schedule. Provider Administered Drugs (PADs) billing requirements changed - they must now be verified against specific drug lists to determine if they should be billed as pharmacy or medical claims.
Get alerts when payers change rules like this one
We check L.A. Care Health Plan and other payers every day and email you when a change matches your specialty and state.
Get L.A. Care Health Plan alertsPolicy Monitoring is free. No card required.
What to do
immediately · 5 steps
01Billing team must verify all Provider Administered Drugs against the Contract Drugs List and Medi-Cal Rx Pharmacy Reimbursable PAD list before billing.
02Update billing workflows to check drug lists first - bill as pharmacy claims if on the lists, otherwise bill as medical claims subject to 1% reduction.
03Contact LACareTRI@lacare.org for TRI Fee Schedule questions and DirectNetwork@lacare.org for general inquiries.
04Do not assume previous L.A.
05Care pharmacy coverage guarantees current Medi-Cal Rx coverage.
Original notice
Provider Payment Reductions and Billing Guidelines
lacare.org · Always check the source before changing claims.