BOM Toolkit

Medicare’s Annual Enrollment Period begins October 15. Blue Shield of California has announced its 2027 Medicare portfolio, including Medicare Advantage products that use tailored provider networks. The announcement does not identify practice-level network changes, so physicians should not assume that 2026 participation or directory information automatically carries forward. Before patients begin comparing plans, verify each 2027 product, service area, referral requirement and directory listing through your contract and the payer’s provider channels. Flag discrepancies promptly and give front-office staff a consistent response for patients asking whether the practice will remain in network.

Review the plan announcement

Actively enrolled Medi-Cal fee-for-service providers must review and update their public directory information during October. Check the office phone and website, whether the practice accepts new Medicaid or CHIP patients, telehealth availability, languages and interpreting capability, and physical-access accommodations. Billing providers update through the Medi-Cal Provider Portal under “Manage Organization” and “Public Fee-for-Service Provider Directory”; only Organization Administrators and NPI Administrators can edit. Non-billing rendering, ordering, referring, providing and non-physician medical practitioners use DHCS’s Provider Directory Survey. Important: updating an enrollment record in PAVE does not satisfy this directory requirement. Confirm portal access now and complete the review during October.

DHCS provider-directory instructions

DHCS webinar for providers and advocates on Wednesday, September 30, 2026, from 10 to 11 a.m. Pacific time.

Approximately two million Medi-Cal members with Unsatisfactory Immigration Status are expected to move from managed care to fee-for-service on January 1, 2027, according to a September 2026 DHCS Policy Guide. The change affects how members obtain care and how providers are paid. It does not, by itself, end members’ Medi-Cal eligibility; members must continue to renew on time to keep full-scope coverage.

For practices, the immediate question is whether they can continue caring for affected patients through Medi-Cal fee-for-service. Members will be able to see doctors, clinics and hospitals that accept fee-for-service, with the state paying providers directly for covered services. Practices should check their enrollment and billing readiness, along with applicable authorization requirements, before the transition.

Care continuity also needs attention. Patients with ongoing treatment, scheduled procedures or medical equipment may…

Federal Medi-Cal eligibility changes taking effect in 2027 could create new coverage disruptions for some Los Angeles County patients.

Beginning January 1, 2027, certain adults ages 19–64 in Medi-Cal’s adult expansion group may need to meet work, school, volunteer, or other qualifying activity requirements to maintain coverage. Beginning March 1, some affected adults may also need to renew eligibility every six months instead of annually.

Keep L.A. Covered has launched as a countywide resource to help residents understand the changes, respond to notices, and connect with enrollment assistance. LACMA is a coalition partner in the campaign.

What Practices Should Do

• Share KeepLACovered.org through patient portals, appointment reminders, after-visit summaries, and waiting-room materials.

• Encourage patients to update contact information so important Medi-Cal notices reach them.

CMA is pushing back against proposed Medicare payment policies that would further destabilize physician practices, including a 50% cut to certain services billed with Modifier 25, while supporting bipartisan legislation to establishstable, inflation-based updates. CMA has also released its 2026 Physician Voter Guide and announced its opposition to Proposition 39, a November ballot measure that would restrict Californians’ ability to vote. On National Physician Suicide Awareness Day, CMA is also calling for continued action to reduce stigma and remove barriers that prevent physicians from seeking mental health care. Other updates include an impending Medi-Cal transition affecting approximately 2 million patients with unsatisfactory immigration status, the reprocessing of certain Blue Shield psychotherapy claims following CMA advocacy, and new respiratory virus immunization recommendations.

CMS’s ACCESS model connects Original Medicare patients with participating organizations that provide technology-supported chronic care between office visits. Eligible Part B practitioners may receive a $30 co-management payment after reviewing an ACCESS care update and completing at least one documented coordination activity, such as reconciling medications or updating a problem list. CMS requires at least five minutes of practitioner time, and a $10 first-time onboarding add-on may apply. The payment is separate from distinct covered office visits. Practices should identify enrolled patients, confirm how updates enter the workflow and review CMS documentation and diagnosis-code requirements before billing.

Primary source: CMS billing guidance

California has enacted AB 1126 to reduce billing barriers when a Medi-Cal managed care member also has other health coverage and Medi-Cal pays last. For affected patients, a provider enrolled in Medi-Cal fee-for-service generally will not have to join the managed care plan’s network simply to bill Medi-Cal-allowable balances. Plans may still require an agreement in certain situations, including services needing prior authorization or continuity-of-care arrangements. This is not an immediate workflow change. DHCS must issue implementation guidance and obtain any necessary federal approvals. Practices can begin identifying these crossover claims, but should wait for DHCS and plan instructions before changing billing procedures.

Primary source: AB 1126 chaptered text

Approximately 2 million Medi-Cal members with unsatisfactory immigration status will move from managed care to Medi-Cal fee-for-service on January 1, 2027. Physicians who want to continue caring for affected patients should confirm that they are enrolled and eligible to bill Medi-Cal FFS through PAVE using their Type 1 NPI. Practices should also review the Medi-Cal FFS fee schedule, claims process and Treatment Authorization Request requirements, because services will no longer be paid under managed-care contracts. Ask contracted plans which patients may transition and begin mapping continuity needs now. DHCS plans additional guidance for people receiving ongoing or complex treatment later this year.

CMA practice guidance

The updated state file makes an NPI-by-NPI check timely for practices that order, refer or prescribe for Medi-Cal patients.

What changed: California's public provider-enrollment dataset was updated September 7 with records through August 31. CMA says phased enforcement could begin as early as February 2027 and enrollment can take up to 90 days.

Who it affects: Especially solo, small and independent practices whose physicians prescribe or refer for Medi-Cal members. Enrollment with a managed care plan or Medicare alone does not satisfy the individual Type 1 NPI requirement.

Your move: Ask practice managers to run each prescriber's Type 1 NPI against the refreshed roster and start PAVE enrollment for any gap.

DHCS enrolled-provider dataset  ·  CMA enrollment guidance

Practices may have only five months before denials begin for orders, referrals and prescriptions from non-enrolled clinicians.

What changed: Yesterday’s brief noted that DHCS had not announced an enforcement date. CMA reported later September 2 that phased enforcement could begin as early as February 2027.

Who it affects: Physicians and other clinicians who order, refer or prescribe for Medi-Cal patients must be enrolled individually under a Type 1 NPI. Managed care, Medicare or Medi-Cal Rx enrollment alone does not satisfy the requirement.

Your move: Check every prescriber now. Applications can take up to 90 days, and submission alone does not prevent denials.

Review CMA’s enrollment guidance