26-338 Behavioral Health Claims Reimbursement Update

Date: 03/16/26

Aligning billed charges with contracted payment amounts

Beginning May 18, 2026, behavioral health claims reimbursement will not exceed the billed charges on the claim unless there is interest paid due to late reimbursement. Additional claim validation will be applied to ensure payment amounts do not exceed the billed charge submitted for the service.

When this change takes effect

This change applies to claims processed on or after May 18, 2026, regardless of the date of service.

Why this change is being made

This update reflects standard reimbursement practices and promotes consistent, accurate claims processing by reducing payment discrepancies and aligning billed charges with payment amounts.

What this change means for you

• Payments will not exceed the billed charges submitted on the claim.
• Contracted rates, reimbursement methodologies and covered behavioral health services are not changing.
• Providers are encouraged to review billing practices to ensure billed charges are based on services rendered, align with standard reimbursement practices, and are submitted in accordance with their Provider Participation Agreement (PPA).

Thank you for your partnership

We appreciate your continued partnership in supporting the behavioral health needs of our members.

Need help? Contact us

If you have questions about the information in this update, please contact Behavioral Health Provider Services at 844-966-0298.

 

This information applies to Behavioral Health Providers.

This information applies to Medi-Cal in Imperial County.