26-847 Provider Communications Posted Online and Operations Manual Updates for June 2026

6/12/26

26-736m (PDF), Follow Access to Care Standards to Ensure Patients Get Timely Care

Regulatory

PPGs

• Medi-Cal (all counties)
• Molina

Health plans must maintain provider networks that can serve both adult and pediatric patients across their service areas. This notice outlines the access to care standards that must be met and what to do if gaps are identified.

6/15/26

26-700m (PDF), Access the HEDIS^® Resource Page for the Latest Tip Sheets

News & Announcements

Physicians/
Practitioners

PPGs

Hospitals

Ancillary

ECM

CS

Behavioral Health

• IFP (Ambetter HMO/PPO)
• Employer Group
  (HMO/POS, PPO)
• Medi-Cal (all counties)

Visit the HEDIS Measures & Billing Codes resource page to access tip sheets. The tip sheets provide current Healthcare Effectiveness Data and Information Set (HEDIS^®) measurement descriptions, eligible populations, exclusions, documentation and coding requirements, and best practice guidance.  

26-701m (PDF), Access the HEDIS^® Resource Page for the Latest Tip Sheets

• Medicare Advantage (HMO)

6/26/26

26-685m (PDF), Enhancing Patient Experience Through Timely Access

News & Announcements

Physicians/
Practitioners

PPGs

Hospitals

Ancillary

ECM

CS

Behavioral Health

• IFP (Ambetter HMO/PPO)
• Employer Group
  (HMO/POS, PPO)
• Medi-Cal (all counties)
• Molina

This flyer has been updated since its February 2026 release to include current appointment wait time standards. Adhering to these standards helps providers meet regulatory requirements and improve the patient experience.

26-686m (PDF), Enhancing Patient Experience Through Timely Access

• Medicare Advantage (HMO)

6/29/26

26-758m, Meet TRC and FMC Requirements: Required Documentation and Timelines

News & Announcements

Physicians/
Practitioners

PPGs

•  Medicare Advantage (HMO)

Access a new standardized checklist of required timelines, documentation, and billing guidance to ensure compliance with the Transitions of Care (TRC) and Follow-Up After Emergency Department Visit (FMC) measures, which support accurate reporting and reduce care gaps.

6/29/26

26-818m, Updates to Clinical Policies – May 2026

Contractual

Physicians/
Practitioners

PPGs

Behavioral Health

• IFP (Ambetter HMO/PPO)
• Employer Group
  (HMO/POS, PPO)
• Medi-Cal (all counties)

Review changes to medical policies for procedures and services for May 2026. Medical policies are available online. Medical policies offer guidelines for determining medical necessity for certain procedures, equipment and services. As a reminder, all services must be medically necessary, and member benefits, legal and regulatory mandates take precedence over content of medical policies and must be applied first.

6/30/26

26-802m (PDF), Avoid Denials and Payment Delays: Billing Requirements for Dyadic Services

News & Announcements

Behavioral Health

• Medi-Cal (all counties)
• Molina

Explains how behavioral health providers should bill for dyadic services. While services may include support for a parent or caregiver, they must directly support the child’s needs.

6/9/26

Mandatory Notification Requirements for PPG Downstream Hospital Terminations (under Provider Oversight > Facility and Physician Additions Changes and Deletions)

All

• HMO, PPO, Medi-Cal
  
  

Updated documents with information related to expanded notification requirements for PPG and hospital network terminations, including earlier reporting expectations, required information and compliance obligations to support timely regulatory review and approval. These changes are related to the Department of Health Care Services (DHCS) All Plan Letter 25-019.

Closure and Termination

(under Provider Oversight > Facility and Physician Additions Changes and Deletions)

All

• Medi-Cal 
  

• PPGs

• HMO
  

PPG and Hospital Termination

(under Provider Oversight > Facility and Physician Additions Changes and Deletions)

• PPGs
• Hospitals

• HMO, PPO
  

6/12/26

Medi-Cal Participation Requirements for Reimbursement

(under Claims and Provider Reimbursement) 

All

• Medi-Cal
  

New document explaining that Medi-Cal reimbursement is based on the rendering provider’s participation status, not the group contract. Rendering providers must be credentialed, enrolled with DHCS and listed on the provider roster at the time of service. Claims may be denied if these requirements are not met.

6/25/26

Financial Risk Responsibilities

(under Benefits > Transplant) 

• PPGs
• Hospitals

• Medi-Cal
  

New document explaining financial responsibility for major organ transplant services assigned under the Division of Financial Responsibility (DOFR), including post-transplant services based on the time since discharge.

6/26/26

Hospice Care

(under Benefits)

All

• Medicare
  

Updated document with information to reflect current guidance for hospice care services and claims processing.

6/24/26

Bariatric Surgery Performance Centers

(under Forms and References)

All

• HMO, PPO (PDF)

Updated the Bariatric Surgery Performance Centers list.

Ambetter from Health Net IFP

Ambetter PPO

844-463-8188

email

Ambetter HMO

888-926-2164

email

Health Net Employer Group HMO, POS, & PPO

800-641-7761

email

Medicare (Individual & Employer Group)

(Wellcare By Health Net)

800-929-9224

email

Medicare Supplement

800-641-7761

email

Medi-Cal (including CS and ECM providers)

800-675-6110

N/A