25-561 Ensure Prompt Claims Payments with the Right Emergency Code Modifiers
Date: 06/02/25
Guidelines for providers in Southern California impacted by wildfires to expedite claims and ensure timely payments
On April 29, 2025, Health Net released provider update 25-395, Relief for Providers Impacted by Southern California Wildfires. The update informed impacted physicians and other providers in Los Angeles and Ventura counties about flexible provisions available due to the State of Emergency declared by Governor Newsom.
To assist impacted providers, both contracted and non-contracted, claim submission deadlines have been extended to 365 days from the date of service beginning January 7, 2025, until the State of Emergency is lifted, as per California Code of Regulations, title 28, section 1300.71(b).
Include CR or DR code modifiers for accurate claims processing
Effective August 6, 2025, physicians and other providers in Los Angeles and Ventura counties affected by the Southern California wildfires must adhere to the Centers for Medicare & Medicaid Services (CMS) billing and coding guidelines for proper claims submission. This includes adding one of the following emergency code modifiers to claims as appropriate.
- CR Modifier: Catastrophe/Disaster Related
- DR Condition Code: Disaster Relief
Providers must ensure the correct emergency code modifier is applied for claims to reflect the emergency-related flexibilities. Following these guidelines will help expedite claims processing and payment.
Additional resources
For additional information and benefits available during a disaster, physicians and providers can access Health Net’s public-facing resource web page.
This page provides valuable insights and updates on coverage flexibility, claims assistance, and more. You can also access provider update 25-395 in the Provider Library.
Additional information
Moving forward, in instances where the Department of Health Care Services (DHCS) guidelines are silent, Health Net will follow CMS coding and billing guidelines to ensure compliance and consistency in our practices.
Relevant sections of Health Net’s provider operations manuals and the Behavioral Health Provider Operations Manual have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on Health Net’s provider portal.
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal. Behavioral health providers can call 844-966-0298.
Provider Services
Line of business | Phone number |
|---|---|
Ambetter from Health Net IFP Ambetter PPO | |
Ambetter HMO | |
Health Net Employer Group HMO, POS, & PPO | |
Medi-Cal (including CS and ECM providers) |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.
For Medi-Cal, this information applies to Los Angeles County.