23-1347 Changes to Reimbursement Process for American Indian Clinics

Date: 11/17/23

Two-part payment process instead of one payment

Starting January 1, 2024, California Health & Wellness Plan (CHWP) members in Amador, Calaveras, Inyo, Mono, and Tuolumne counties will transition to Health Net Community Solutions, Inc., (Health Net) while members in Imperial County will transition to Community Health Plan of Imperial Valley (CHPIV).

These transitions mean providers will receive a two-part reimbursement for the total amount due: one for the initial reimbursement for the first-time claim and one for the services eligible for the Office of Management and Budget (OMB) rate.

• Payment 1 –The standard Medi-Cal allowable amount for the visit.
• Payment 2 – The rest of the amount making up that year’s OMB rate.

The OMB rate will not be applied on the initial reimbursement for the first-time claim and instead paid separately.

Your payments are secure, and there are no reductions!

We want to assure you that there are no reductions to your payments. You will still receive the same amount as before, and payments will continue to be processed within the regulatory timeline. The difference is, you’ll receive two separate payments that comprise the total amount due to you.

Additional information

If you have questions regarding this change, contact the Health Net Medi-Cal Provider Services Center at 800-675-6110.

 

This information applies to Indian Health Clinics/Tribal/Urban Indian Health Centers.

For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Mono, Imperial, and Tuolumne counties.