24-188 A Change in Our Claims Pricing System May Improve the Accuracy of Your Payment

Date: 02/16/24

Minimal reimbursement impacts on claims

Health Net, on behalf of Community Health Plan of Imperial Valley (CHPIV), has recently transitioned to a new claims pricing system. As a result, within the second quarter of 2024 there will be changes to your claims payments. Rest assured, the payment methodology we use aligns with the necessary Medicare and Medi-Cal guidelines.

Here's what you need to know about any potential impact:

• Adjustments in claims reimbursement for durable medical equipment (DME) supplies billed with DME modifiers. In the past, these claims were mistakenly aligned with Medicare's fee schedule, potentially resulting in overpayments to you. With the new system, these claims now accurately align with Medi-Cal's fee schedule as applicable. This realignment could affect future claims reimbursement. However, we want to assure you that any previous overpayments made based on the incorrect fee schedule will not be recouped.

• Submitting your full 9-digit zip code (including the 4-digit extender) is crucial when filing Medicare claims. This ensures proper alignment with Medicare's fee schedule when applicable.

Additional information

If you have questions regarding the information contained in this update, contact the Community Health Plan of Imperial Valley at 833-236-4141.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

This information applies to Medi-Cal in Imperial county.