25-543 TRI Fee-for-Service Payments Are Now Applied to New Claims
Date: 05/30/25
Payments began on May 31, 2025.
Health Net, on behalf of CalViva Health, is paying Targeted Rate Increase (TRI) fee-for-service (FFS) payments via new day claims instead of retroactive adjustments.
As a reminder, health plans had until December 31, 2024, to retroactively implement rate increases for FFS claims for dates of service on or after January 1, 2024. On October 22, 2024, the Plan started making retroactive adjustments going back to January 1, 2024. Effective on or about May 31, 2025, TRI payments will be paid using new day claims.
Online resources
The Plan offers resources you can use to educate staff and help ensure compliance. Go to Health Net webpage > Providers > 2024 DHCS Targeted Rate Increase for Select Medi-Cal Services > Get Resources. You can also visit the links below.
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Additional information
Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more. If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569. Behavioral Health providers can call 844-966-0298.
This information applies to Physicians, Doulas, and Behavioral Health Providers.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.