Medi-Cal Targeted Rate Increases
Starting in December 2024, some providers might see changes to their claims because of DHCS targeted rate increases (TRI). This is related to APL 24-007, which increases payment rates for certain services and provider types to no less than 87.5 percent of the lowest California-specific Medicare locality rate. These changes aim to address disparities, ensure the financial viability of providers and improve overall quality of care and access for Medi-Cal members.
TRI eliminate applicable AB 97 provider payment reductions and include any applicable Proposition 56 payments.
The Alliance is required to ensure that network providers, as defined in APL 19-001, receive no less than the TRI for applicable services. TRI does not apply to non-contracted providers or providers operating under a Letter of Agreement. Where there is a conflict between this notice and state law and/or DHCS guidance, the Alliance plans to follow state law and/or DHCS guidance, as applicable.
You can read about the full text of APL 24-007 on our website.
Contact Provider Services
| General | 831-430-5504 |
| Claims Billing questions, claims status, general claims information |
831-430-5503 |
| Authorizations General authorization information or questions |
831-430-5506 |
| Authorization Status Checking the status of submitted authorizations |
831-430-5511 |
| Pharmacy Authorizations, general pharmacy information or questions |
831-430-5507 |