Medicare & Medicaid · Oct 11, 2026

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Billing & paymentMedicare & MedicaidNew in this edition

Unpaid qualifying APM participants face October 13 billing-information cutoff

Certain unpaid qualifying APM participants must provide billing information by October 13 to avoid forfeiting their 2026 incentive. The October 5 Federal Register correction restores the download hyperlink; it does not extend the deadline. The payment concerns 2024 qualification and a 2025 payment base.

High priority · Oct 11, 2026 editionRead story →

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Billing & paymentMedicare & MedicaidNew in this edition

Medi-Cal clinic institutional claims require diagnosis codes from October 15

Medi-Cal adds a clinically appropriate diagnosis requirement to specified clinic institutional claims submitted from October 15. The notice uses submission date, rather than establishing a new service-date cutoff.

High priority · Oct 11, 2026 editionRead story →

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Provider operationsMedicare & MedicaidNew in this edition

DHCS warns assisted living waiver facilities of denials and reprocessing

DHCS warns that ALW compliance failures can cause nonpayment and reprocessing of earlier paid claims. Its October 9 notice connects eligibility and billing controls with facility-specific follow-up, without announcing one universal correction deadline.

High priority · Oct 11, 2026 editionRead story →

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Billing & paymentMedicare & MedicaidContinuing

Medi-Cal youth gender-affirming services: October 13 reimbursement and continuity requirements

APL 26-018 pairs youth reimbursement limits with a restricted hormone transition, preserved services, continuity coordination, and plan notices.

High priority · Oct 11, 2026 editionRead story →

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Billing & paymentMedicare & MedicaidContinuing

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Medicare & Medicaid · Oct 11, 2026

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