All Insurance Policy Changes (Page 665)

Continuing from page 664. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
25-579 State of Emergency: Support for Members in San Joaquin and Trinity Counties for Ongoing Recovery
Health Net·Identified Jun 20, 2026
Health Net is providing emergency support for members in San Joaquin and Trinity Counties affected by levee failure and severe storms, including expedited prior authorizations, extended claim filing deadlines, and approval for out-of-network services when regular providers are unavailable.
Low impact
25-532 Do You Want Your Gender-Affirming Services Displayed in Provider Directories?
Health Net·Effective Feb 14, 2025
Effective February 14, 2025, CalViva Health (Medi-Cal) requires providers to complete a survey by June 13, 2025, indicating whether they offer gender-affirming services and want this information displayed in provider directories. This is a mandatory reporting requirement for directory compliance, not a billing change.
Low impact
25-533 Do You Want Your Gender-Affirming Services Displayed in Provider Directories?
Health Net·Effective Feb 14, 2025
Health Net requires providers to complete a survey by June 13, 2025 to indicate whether they offer gender-affirming services and want this information displayed in provider directories. This is required by California's Department of Health Care Services effective February 14, 2025.
High impact
25-545 New Claims Prepayment Review Policy Will Confirm if Documentation Supports Billed Charges
Health Net·Effective Aug 12, 2025
Health Net will implement prepayment claim reviews using Optum's Comprehensive Payment Integrity tool for Marketplace HMO/PPO products starting August 12, 2025. Providers may receive requests for medical records and billing documents to support billed charges, and failure to submit requested documentation will result in technical denials until information is provided.
Medium impact
25-531 Do You Want Your Gender-Affirming Services Displayed in Provider Directories?
Health Net·Effective Feb 14, 2025
Health Net requires providers to complete a survey by June 13, 2025 to indicate whether they offer gender-affirming services and want this information displayed in provider directories. This is a new requirement from the Department of Health Care Services effective February 14, 2025.
Low impact
25-534 Provider Communications Posted Online and Operations Manual Updates for May 2025
Health Net·Identified Jun 20, 2026
Health Net California published a comprehensive summary of 8 provider communications and 4 operations manual updates from May 2025, covering pharmacy updates, telehealth benefits, prescription guidelines, and behavioral health screening requirements. This is an informational compilation of previously issued changes rather than new policy requirements.
Medium impact
25-536 Provider Communications Posted Online and Operations Manual Updates for May 2025
Health Net·Effective May 1, 2025
HealthNet California published May 2025 updates including biosimilar medication preferences, medical policy changes, anesthesia/facility fee reminders for dental procedures, and expanded maternal mental health screening requirements for Medi-Cal members. Several operations manual sections were updated including obesity benefits, durable medical equipment ordering, and transplant center lists.
Medium impact
25-537 Provider Communications Posted Online and Operations Manual Updates for May 2025
Health Net·Effective May 1, 2025
HealthNet California published May 2025 provider communications and operations manual updates covering biosimilar medication preferences, medical policy changes, dental anesthesia fee responsibilities, and behavioral health resources. Key updates include removal of the Fit Families for Life Program, new blood pressure monitor ordering procedures through Western Drugs, updated transplant center lists, and expanded AB936 maternal mental health screening requirements for Medi-Cal members.
Medium impact
25-521 Help Ensure Medi-Cal Members Get the ECM and CS Services They Need
Health Net·Effective Jul 1, 2025
New closed-loop referral requirements for Medi-Cal Enhanced Care Management (ECM) and Community Supports (CS) services become effective July 1, 2025. Providers must use electronic communication methods, submit monthly data files by the 5th of each month via SFTP, and use specific platforms (Provider Portal or Findhelp) for referrals.
Medium impact
25-520 Help Ensure Medi-Cal Members Get the ECM and CS Services They Need
Health Net·Effective Jul 1, 2025
Health Net is implementing new closed-loop referral requirements for Medi-Cal Enhanced Care Management (ECM) and Community Supports (CS) services, requiring providers to track referrals through completion and submit monthly data files by the 5th of each month. Electronic communication methods will be mandatory, with fax only allowed by mutual agreement.
Medium impact
25-519 Help Ensure Medi-Cal Members Get the ECM and CS Services They Need
Health Net·Effective Jul 1, 2025
Health Net California is implementing new closed-loop referral requirements for Medi-Cal Enhanced Care Management (ECM) and Community Supports (CS) services, requiring providers to use electronic communication methods and submit monthly data files by the 5th of each month. Providers must track referrals through completion and use specified platforms like the provider portal and Findhelp for making referrals.
Low impact
25-562m Maximize Your Access and Availability: Join Our No-Cost Webinars!
Health Net·Effective Jun 9, 2025
HealthNet California is offering no-cost webinars for providers in Fresno, Kings, and Madera counties to help them understand requirements and best practices for access and availability. This appears to be an educational offering rather than a policy change affecting billing or clinical operations.
Low impact
25-563m Maximize Your Access and Availability: Join Our No-Cost Webinars!
Health Net·Effective Jun 9, 2025
HealthNet California is offering free webinars to help providers understand requirements and best practices for access and availability standards. This is an educational opportunity specifically for Medi-Cal providers in Imperial County to stay informed about compliance requirements.
Low impact
25-564m Maximize Your Access and Availability: Join Our No-Cost Webinars!
Health Net·Identified Jun 20, 2026
HealthNet California is offering no-cost webinars to help providers stay informed about requirements and best practices for maximizing access and availability. This is an educational opportunity rather than a policy requirement change.
Low impact
25-565m Maximize Your Accessand Availability: JoinOur No-Cost Webinars!
Health Net·Effective Jun 9, 2025
HealthNet California is offering no-cost webinars to help providers stay informed about requirements and best practices for maximizing access and availability. This is an educational opportunity rather than a policy change affecting billing or coverage.
Medium impact
25-299m Dyadic Care Services Approved for Reimbursement at Medi-Cal Fee-for-Service (FFS) Rates
Health Net·Effective Mar 15, 2023
FQHCs, RHCs, and Tribal Health Programs can now receive additional Medi-Cal Fee-for-Service payments for dyadic care services (preventive behavioral health services for children 0-20 and their caregivers) delivered on the same day, in addition to their standard PPS payments. Physicians, including psychiatrists, are now eligible providers for these services.
Medium impact
25-298m Dyadic Care Services Approved for Reimbursement at Medi-Cal Fee-for-Service (FFS) Rates
Health Net·Effective Mar 15, 2023
Medi-Cal now reimburses FQHCs, RHCs, and Tribal Health Programs at additional Fee-for-Service rates for dyadic care services (preventive behavioral health for children 0-20 and caregivers) when delivered on the same day, effective retroactively to March 15, 2023. Eligible providers now include physicians and psychiatrists who can bill for these integrated child-caregiver mental health services.
Medium impact
25-297m Dyadic Care Services Approved for Reimbursement at Medi-Cal Fee-for-Service (FFS) Rates
Health Net·Effective Mar 15, 2023
FQHCs, RHCs, and Tribal Health Programs can now receive additional Medi-Cal FFS reimbursement for dyadic care services (behavioral health services for children under 21 and their caregivers) delivered on the same day, in addition to their standard PPS payment. The policy also expands eligible providers to include physicians and psychiatrists for dyadic services billing.
High impact
25-601 Simplify Your Online Service Experience
Health Net·Effective Jul 1, 2025
Health Net is transitioning from MHN provider portal to Availity Essentials starting August 20, 2025, with new prior authorization requirements for behavioral health services beginning July 1, 2025. Providers must register for Availity Essentials to continue submitting claims and prior authorizations online.
High impact
25-602 Simplify Your Online Service Experience
Health Net·Effective Aug 20, 2025
Starting August 20, 2025, the MHN provider portal and email-based claims submissions will be discontinued. Behavioral health providers must transition to Availity Essentials for claims submission, tracking, and other self-service functions, or continue using the existing Health Net provider portal with limited features.
High impact
25-603 Simplify Your Online Service Experience
Health Net·Effective Aug 20, 2025
Starting August 20, 2025, the MHN provider portal and email-based claims submissions will be discontinued. Providers must transition to Availity Essentials for claims submission, tracking, and member eligibility verification to maintain billing operations.
Low impact
25-003m Assist Members With Getting Care Fast
Health Net·Effective Jun 13, 2025
HealthNet California has issued guidance encouraging providers to help Medi-Cal members access same-day care options. This appears to be informational guidance rather than a policy change requiring specific billing modifications.
Medium impact
25-572 Mandatory Learning: How to ReduceImplicit Bias for Maternal Health
Health Net·Effective Jun 16, 2025
HealthNet California requires physicians to complete mandatory training on reducing implicit bias for maternal health to comply with California's Dignity in Pregnancy and Childbirth Act (SB 464). This training requirement applies to physicians serving Medi-Cal patients in specific California counties.
Low impact
25-573 Mandatory Learning: How to ReduceImplicit Bias for Maternal Health
Health Net·Effective Jun 16, 2025
HealthNet California requires physicians serving Medi-Cal patients in Fresno, Kings, and Madera counties to complete mandatory implicit bias training for maternal health to comply with California's Dignity in Pregnancy and Childbirth Act (SB 464). This is a provider compliance requirement rather than a billing change.
Medium impact
25-574 Mandatory Learning: How to ReduceImplicit Bias for Maternal Health
Health Net·Effective Jun 16, 2025
HealthNet California requires physicians providing maternal health services to complete mandatory implicit bias training to comply with the California Dignity in Pregnancy and Childbirth Act (SB 464). This training requirement applies specifically to Medi-Cal providers in Imperial County.

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Archive by year

2023 2024 2025 2026

25-579 State of Emergency: Support for Members in San Joaquin and Trinity Counties for Ongoing Recovery

25-532 Do You Want Your Gender-Affirming Services Displayed in Provider Directories?

25-533 Do You Want Your Gender-Affirming Services Displayed in Provider Directories?

25-545 New Claims Prepayment Review Policy Will Confirm if Documentation Supports Billed Charges

25-531 Do You Want Your Gender-Affirming Services Displayed in Provider Directories?

25-534 Provider Communications Posted Online and Operations Manual Updates for May 2025

25-536 Provider Communications Posted Online and Operations Manual Updates for May 2025

25-537 Provider Communications Posted Online and Operations Manual Updates for May 2025

25-521 Help Ensure Medi-Cal Members Get the ECM and CS Services They Need

25-520 Help Ensure Medi-Cal Members Get the ECM and CS Services They Need

25-519 Help Ensure Medi-Cal Members Get the ECM and CS Services They Need

25-562m Maximize Your Access and Availability: Join Our No-Cost Webinars!

25-563m Maximize Your Access and Availability: Join Our No-Cost Webinars!

25-564m Maximize Your Access and Availability: Join Our No-Cost Webinars!

25-565m Maximize Your Accessand Availability: JoinOur No-Cost Webinars!

25-299m Dyadic Care Services Approved for Reimbursement at Medi-Cal Fee-for-Service (FFS) Rates

25-298m Dyadic Care Services Approved for Reimbursement at Medi-Cal Fee-for-Service (FFS) Rates

25-297m Dyadic Care Services Approved for Reimbursement at Medi-Cal Fee-for-Service (FFS) Rates

25-601 Simplify Your Online Service Experience

25-602 Simplify Your Online Service Experience

25-603 Simplify Your Online Service Experience

25-003m Assist Members With Getting Care Fast

25-572 Mandatory Learning: How to ReduceImplicit Bias for Maternal Health

25-573 Mandatory Learning: How to ReduceImplicit Bias for Maternal Health

25-574 Mandatory Learning: How to ReduceImplicit Bias for Maternal Health