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L.A. Care Health PlanMedicaid · Reimbursement · Reimbursement · CAHigh impact

Direct Network FFS Targeted Rate Increases Unilateral Notification

Act
by Dec 31, 2024
Effective date
Jan 1, 2024
Identified
Jun 20, 2026

Summary

L.A. Care is implementing Targeted Rate Increases (TRI) retroactive to January 1, 2024, which will automatically pay the higher of your contracted rate or the new TRI rate for specific CPT codes. For 2024 services, they will make one-time true-up payments by December 31, 2024, and starting January 1, 2025, claims systems will automatically pay the higher rate while discontinuing separate Prop 56 payments.

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What to do

by Dec 31, 2024 · 5 steps
01Review all 2024 claims for TRI-applicable CPT codes to verify receipt of one-time true-up payments from L.A.
02Care.
03Starting January 1, 2025: Update billing expectations as L.A.
04Care will automatically pay the higher of contracted rates or TRI rates, and discontinue separate Prop 56 equivalent payments.
05Monitor reimbursements to ensure proper payment of higher rates for applicable services.

Original notice

Direct Network FFS Targeted Rate Increases Unilateral Notification
lacare.org · Always check the source before changing claims.
View original ↗

Related changes

See all L.A. Care Health Plan changes →
Targeted Rate Increases (TRI)MediumNo effective date · ReimbursementBrowse every L.A. Care Health Plan change in the policy list

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