What types of policy changes does Health Net issue?

Health Net regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Health Net update its policies?

Health Net typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Health Net policy changes are tracked here?

This page currently tracks 50 documented Health Net policy changes. New items are added as they are identified.

What should I do when Health Net changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

PAYER POLICY CHANGES

Health Net Policy Changes & Prior Auth Updates

We track 50 documented policy changes from Health Net across CA. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Health Net notice. Use the related links below to narrow results by specialty or state, or create a free alert to get new Health Net updates by email (daily or weekly, your choice, on every plan).

Health Net · Effective Nov 12, 2026High impact
26-1071 Post-Decision Peer-to-Peer Reviews No Longer Available as a Method to Challenge Inpatient and Post-Acute Care Determinations
Effective November 12, 2026, peer-to-peer (P2P) reviews can no longer be used to challenge adverse Medicare inpatient and post-acute care authorization determinations for Medicare Advantage and D-SNP plans. Providers must now submit reconsideration requests through the formal Medicare appeals process. Educational P2P discussions remain available but cannot change determination outcomes.
Health Net · Effective Nov 17, 2026High impact
26-1061sum Summary Update: 3rd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk
Health Net California has updated the Injectable Medication HCPCS/DOFR (Division of Financial Responsibility) Crosswalk effective November 17, 2026, adding 11 new injectable medications, 15 new biosimilars, 6 new generic medications, and making 27 updates to existing codes with 3 DOFR categorization corrections. Billing teams must obtain and implement the complete crosswalk update (26-1061) to ensure accurate claims processing and proper financial responsibility assignments for injectable medications.
Health Net · Effective Nov 17, 2026High impact
26-1062sum Summary Update: 3rd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk
Health Net/Community Health Plan of Imperial Valley updated the Injectable Medication HCPCS/DOFR Crosswalk effective November 17, 2026, adding 11 new injectable medications, 15 new biosimilars, 6 new generic medications, and making 27 updates to existing codes, plus 3 DOFR categorization corrections. Billing teams must obtain and implement the complete crosswalk update (26-1062) to ensure accurate coding and financial responsibility assignment for all injectable medication claims.
Health Net · Effective Nov 17, 2026High impact
26-1060sum Summary Update: 3rd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk
Health Net's Pharmacy Advisory Committee has updated the Injectable Medication HCPCS/DOFR Crosswalk effective November 17, 2026, adding 11 new injectable medications, 15 new biosimilars, 6 new generic medications, and making 27 updates to existing codes. The update includes 3 DOFR categorization corrections, 2 administrative changes, and 21 code description updates that will affect how injectable medications are billed and assigned to financial responsibility categories under the Health Net Provider Participation Agreement.
Health Net · Effective Jan 1, 2027High impact
26-1291 2027 Medicare Advantage and Special Needs Plan Updates: What You Need to Know
Effective January 1, 2027, Wellcare By Health Net is restructuring Medicare Advantage, D-SNP, and C-SNP plans across California counties, including plan name changes, plan segmentation, one plan termination, a new dental vendor (Liberty Dental Plan), and expansion of SSBCI benefits to D-SNP members. The practice must verify member plan assignments and benefits before rendering services, update charge entry to reflect accurate diagnosis codes for SSBCI eligibility, confirm dental network participation with the new vendor, and respond promptly to member attestation requests for C-SNP enrollment.
Health Net · Effective Jan 1, 2027High impact
26-1008a Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFS
Effective January 1, 2027, Medi-Cal members with Unsatisfactory Immigration Status (UIS) will transition from managed care plans to Medi-Cal Fee-for-Service (FFS). Providers must be enrolled in Medi-Cal FFS by the deadline to continue treating these members and receive reimbursement. Billing processes, claims submission, and authorization requirements will shift from managed care to FFS workflows.
Health Net · Effective Jan 1, 2027High impact
26-1008 Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFS
Effective January 1, 2027, Medi-Cal members with Unsatisfactory Immigration Status (UIS) will transition from managed care to Medi-Cal Fee-for-Service (FFS). Providers must enroll in Medi-Cal FFS through the PAVE system by the deadline to continue treating these members and receive reimbursement. All claims and authorization processes for UIS members will shift from managed care plans to Medi-Cal FFS processing.
Health Net · Effective Jan 1, 2027High impact
26-1009 Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFS
Effective January 1, 2027, Medi-Cal members with Unsatisfactory Immigration Status (UIS) will transition from managed care to Medi-Cal Fee-for-Service (FFS). Providers must be enrolled in Medi-Cal FFS by this date to continue treating these members and receive reimbursement. All billing, claims, and authorization processes will shift from managed care plans to Medi-Cal FFS requirements.
Health Net · Effective Jan 1, 2027High impact
26-1010 Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFS
Effective January 1, 2027, Medi-Cal members with Unsatisfactory Immigration Status (UIS) will transition from managed care to Medi-Cal Fee-for-Service (FFS). Providers must enroll in Medi-Cal FFS through the PAVE system by this date to continue treating affected UIS members and receive reimbursement. All billing, claims submission, and prior authorization processes will shift from managed care plans to Medi-Cal FFS starting January 1, 2027.
Health Net · Effective Jan 1, 2027High impact
26-989 Changes to Community Supports Services, Effective January 1, 2027
Effective January 1, 2027, Health Net will discontinue three Community Supports services: Assisted Living Facility Transitions, Personal Care and Homemaker Services, and Short-Term Post-Hospitalization Housing. Providers must identify affected members, continue services through December 31, 2026, and coordinate care transitions. This impacts Medi-Cal in 10 California counties.
Health Net · Effective Jan 1, 2027High impact
26-991 Changes to Community Supports Services, Effective January 1, 2027
Effective January 1, 2027, Community Health Plan of Imperial Valley is terminating three Community Supports services: Assisted Living Facility Transitions, Personal Care and Homemaker Services, and Short-Term Post-Hospitalization Housing. The billing team must identify all affected members currently receiving these services, ensure services end by December 31, 2026, and coordinate care transitions to avoid service gaps.
Health Net · Effective Jan 1, 2027High impact
26-990 Changes to Community Supports Services, Effective January 1, 2027
CalViva Health is discontinuing three Community Supports services effective January 1, 2027: Assisted Living Facility Transitions, Personal Care and Homemaker Services, and Short-Term Post-Hospitalization Housing. Billing teams must identify affected members, ensure services end by December 31, 2026, and coordinate transition planning to avoid service gaps and claim denials.
Health Net · Effective Mar 5, 2027High impact
26-1187 CMS Changes to Medicare Advantage Risk Score Calculations
CMS is changing Medicare Advantage risk score calculations to exclude diagnoses from unlinked chart reviews (CRRs not connected to eligible claims or encounters) beginning with the PY 2027 mid-year risk score run. Billing teams must submit claims and encounter data promptly—at least 2–3 weeks before CMS submission deadlines—to ensure diagnoses are linked before the applicable deadline, or they will not be included in risk score calculations.
Health Net · Effective Nov 15, 2026Medium impact
26-1317 Transition to InterQual Clinical Review Criteria
Effective November 15, 2026, Wellcare By Health Net will evaluate behavioral health authorization and continued-stay medical necessity reviews using InterQual clinical criteria instead of LOCUS/CALOCUS scoring. Existing authorization submission processes and forms remain the same, so the practice must still submit the clinical information required for review.
Health Net · Effective Dec 15, 2026Medium impact
26-1170 Changes to Behavioral Health Peer-to-Peer Reviews
Effective December 15, 2026, Health Net California will discontinue pre-determination peer-to-peer (P2P) reviews for behavioral health authorization requests in Medi-Cal members across Fresno, Kings, and Madera counties. Post-determination P2P reviews for denied authorizations will remain available. Medical necessity criteria and authorization timeframes are unchanged.
Health Net · Effective Dec 15, 2026Medium impact
26-1171 Changes to Behavioral Health Peer-to-Peer Reviews
Effective December 15, 2026, HealthNet California will discontinue pre-determination peer-to-peer (P2P) reviews for behavioral health prior authorization requests for Medi-Cal members in Imperial County. Post-determination P2P reviews for denied authorizations will remain available. Medical necessity criteria and authorization timeframes are unchanged.
Health Net · Effective Dec 15, 2026Medium impact
26-1172 Changes to Behavioral Health Peer-to-Peer Reviews
Effective December 15, 2026, pre-determination peer-to-peer (P2P) reviews for behavioral health authorization requests will no longer be available for Medi-Cal members in 10 California counties. Post-determination P2P reviews for denied authorizations will continue. Medical necessity criteria and authorization timeframes remain unchanged.
Health Net · Effective Jan 1, 2027Medium impact
26-1201 Updates to Prior Authorization Requirements
Health Net updated its prior authorization lists for California. Preferred and non-preferred status for the denosumab (Prolia, Xgeva and biosimilars) and ustekinumab biosimilars changed effective immediately, and several procedures and equipment codes stopped needing prior authorization for Medicare members effective November 1, 2026 (already in effect). New prior authorization requirements for wound care, scalp cooling and some outpatient drugs start January 1, 2027, and the notice says prior authorization changes do not confirm benefit coverage.
Health Net · Effective Jan 1, 2027Medium impact
26-282m New State-Mandated Chaperone Requirements for Sensitive Ultrasound Exams Start January 1, 2027
Starting January 1, 2027, California providers performing sensitive ultrasound examinations (genitalia, breast, rectum, pubic/groin areas) must notify patients that trained medical chaperones are available, provide chaperones upon request, and document chaperone use in medical records. All staff serving as chaperones must receive specific training on observation techniques, patient draping, neutrality, and reporting procedures.
Health Net · Effective Jan 1, 2027Medium impact
26-281m New State-Mandated Chaperone Requirements for Sensitive Ultrasound Exams Start January 1, 2027
Starting January 1, 2027, California Assembly Bill 849 requires providers performing sensitive ultrasound exams (genitalia, breast, rectum, pubic/groin areas) to notify patients of chaperone availability, provide trained chaperones upon request, and document chaperone presence in medical records. This is a compliance requirement that doesn't affect billing codes or reimbursement but requires new workflows and staff training.
Health Net · Effective Jan 1, 2027Medium impact
26-283m New State-Mandated Chaperone Requirements for Sensitive Ultrasound Exams Start January 1, 2027
Starting January 1, 2027, California providers performing sensitive ultrasound exams (genitalia, breast, rectum, pubic/groin areas) must notify patients of chaperone availability, provide trained chaperones upon request, and document chaperone presence in medical records. This requires new notification procedures, staff training protocols, and documentation workflows.
Health Net · Effective Feb 28, 2027Medium impact
26-1099 Health Net to Exit California Commercial Group Business Starting February 28, 2027
Health Net is discontinuing its Commercial Group health plans in California, with coverage ending starting February 28, 2027, though some employer groups may retain coverage longer based on individual contracts. Existing coverage, provider participation, and billing processes remain unchanged at this time, but the billing team must monitor future communications for claims submission, authorization, and payment runout procedures that will be detailed as the transition approaches.
Health Net · Effective Jan 1, 2028Medium impact
26-373 New California Credentialing Requirements Under AB 1041: Phased Implementation (2026-2028)
California AB 1041 mandates that all provider credentialing and recredentialing applications must be submitted through CAQH starting January 1, 2028. Health Net must make credentialing decisions within 90 days and may provisionally approve eligible providers for up to 120 days when timelines are exceeded.
Health Net · Effective Oct 21, 2026High impact
26-1204 California Children's Services Referral and Care Coordination Requirements
CalViva Health (HealthNet California) has implemented new mandatory requirements for same-day referrals to California Children's Services (CCS) and Medical Therapy Program (MTP) when providers identify members with eligible conditions. Providers must complete clinical evaluations, document qualifying conditions, and submit referrals to county CCS programs on the same day of evaluation. Additionally, transition planning procedures are now required for CCS members aging out of the program, beginning at age 17 with a finalized exit summary by age 20.
Health Net · Effective Oct 21, 2026High impact
26-1205 California Children's Services Referral and Care Coordination Requirements
Community Health Plan of Imperial Valley implemented new California Children's Services (CCS) referral and care coordination requirements, effective immediately. Providers must now submit same-day referrals to county CCS programs when identifying members with CCS-eligible or Medical Therapy Program (MTP)-eligible conditions, and establish transition planning procedures beginning at age 17 and finalizing by age 20.
Health Net · Effective Oct 15, 2026High impact
26-999 ECM Billing Limits Take Effect October 15, 2026
Beginning October 15, 2026, Enhanced Care Management (ECM) claims are subject to a new monthly billing limit of 10 units per member, per calendar month. Claims exceeding this limit will be denied. The billing team must implement controls to ensure accurate unit reporting (1 unit = 1 hour), apply Medicare rounding rules, and maintain detailed documentation to support all billed services and appeals.
Health Net · Effective Oct 15, 2026High impact
26-1000 ECM Billing Limits Take Effect October 15, 2026
Effective October 15, 2026, Enhanced Care Management (ECM) claims are subject to a new monthly billing limit of 10 units per member per calendar month. Claims exceeding this limit will be denied. The policy clarifies that 1 unit equals 1 hour of covered ECM service, specifies which activities are billable versus non-billable, and requires providers to maintain detailed documentation to support appeals of denied claims.
Health Net · Effective Oct 15, 2026High impact
26-1001 ECM Billing Limits Take Effect October 15, 2026
Effective October 15, 2026, Enhanced Care Management (ECM) claims are subject to a new monthly billing limit of 10 units per member per calendar month. Claims exceeding this limit will be denied. Prior authorization is not required, but billing teams must ensure accurate unit reporting (1 unit = 1 hour), maintain supporting documentation, and understand which ECM activities are covered versus non-billable.
Health Net · Effective Oct 13, 2026High impact
26-1186 Reimbursement Changes for Gender-Affirming Care, Effective October 13, 2026
Effective October 13, 2026, Medi-Cal and CHIP will no longer reimburse gender-affirming surgical interventions, puberty blockers, and hormone therapy for minors (under 18 for Medi-Cal, under 19 for CHIP), with a limited transition period through April 12, 2027 for members already receiving hormone therapy. Billing teams must implement prior authorization denials, issue required Notices of Action, and continue billing for non-affected medically necessary services.
Health Net · Effective Oct 13, 2026High impact
26-1184 Reimbursement Changes for Gender-Affirming Care, Effective October 13, 2026
Effective October 13, 2026, Medi-Cal and CHIP plans will no longer reimburse gender-affirming surgical interventions, puberty blockers, and hormone therapy for members under age 18 (CHIP under 19) due to federal funding restrictions. Members receiving hormone therapy Previously due October 13, 2026 (date passed; verify current applicability), may continue reimbursement through April 12, 2027. Billing teams must update authorization workflows, issue Notices of Action to affected members, and continue billing for non-affected medically necessary services.
Health Net · Effective Oct 13, 2026High impact
26-1185 Reimbursement Changes for Gender-Affirming Care, Effective October 13, 2026
Effective October 13, 2026, Medi-Cal and CHIP plans in California (Fresno, Kings, Madera counties) will no longer reimburse gender-affirming surgical interventions, puberty blockers, and hormone therapy for members under age 18/19 due to federal funding restrictions. Members already receiving hormone therapy Previously due October 13, 2026 (date passed; verify current applicability), may continue reimbursement through April 12, 2027. Billing teams must issue Notices of Action for affected authorizations, retain previously approved authorizations for services provided before the cutoff, and continue billing for non-gender-affirming medically necessary services.
Health Net · Effective Oct 1, 2026High impact
26-1243 FQHCs and RHCs Must Use New Telehealth Billing Codes Beginning October 1, 2026
Effective October 1, 2026, FQHCs and RHCs must discontinue billing HCPCS code G2025 for distant-site telehealth services and instead bill the appropriate procedure code with telehealth modifier 93 (audio-only) or 95 (audio/video). This change does not affect reimbursement rates but requires immediate billing workflow updates for practices treating Medicare and commercial telehealth patients.
Health Net · Effective Oct 1, 2026High impact
26-851 Definitive Drug Testing Billing Change, Effective October 1, 2026
Health Net will no longer reimburse CPT codes 80320-80377 for definitive drug testing effective October 1, 2026. Providers must transition to HCPCS G-series bundled laboratory codes (G0480-G0483) to avoid claim denials. All billing systems, charge masters, and workflows must be updated before the effective date.
Health Net · Effective Oct 1, 2026High impact
26-891 Action Required: Comply with QMED 2.0 Encounter Submission Requirements
Health Net has implemented QMED 2.0 encounter data submission standards for capitated PPGs and hospitals, effective October 1, 2026. Billing teams must ensure 90% of encounters are submitted and accepted within 90 days of service, maintain 97.5% correction rate for denied encounters within 10 days, and meet strict accuracy, completeness, and duplicate thresholds or face performance penalties and corrective action.
Health Net · Effective Oct 1, 2026High impact
26-892 Action Required: Comply with QMED 2.0 Encounter Submission Requirements
Health Net California has implemented QMED 2.0 encounter data submission requirements for capitated PPGs and hospitals in Fresno, Kings, and Madera counties. Effective October 1, 2026, providers must meet strict performance thresholds for timeliness (90% of encounters submitted within 90 days), accuracy (97.5% of denied encounters corrected within 10 days), completeness (90% with valid Type 1 rendering provider NPIs), uniqueness (duplicate submissions below 0.5%), and reasonability (total denials below 2%). Failure to comply will result in negative performance reporting, plan-level non-compliance risk, and required corrective action.
Health Net · Effective Oct 1, 2026High impact
26-893 Action Required: Comply with QMED 2.0 Encounter Submission Requirements
Health Net California has implemented QMED 2.0 encounter submission standards for capitated PPGs and hospitals in Imperial County, Medi-Cal. Providers must now meet strict performance thresholds for timeliness (90% of encounters submitted within 90 days), accuracy (97.5% of denied encounters corrected within 10 days), completeness (90% with valid Type 1 rendering provider NPIs), and other quality measures, effective October 1, 2026. Failure to comply will result in negative performance reporting, Plan non-compliance, and corrective action.
Health Net · Effective Sep 15, 2026High impact
26-827sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk
Health Net updated its Injectable Medication HCPCS/DOFR Crosswalk effective September 15, 2026, affecting 10 new injectable medications, 6 new biosimilars, 4 new generic drugs, and 384 updates to existing injectable medication codes. The billing team must obtain and implement the complete crosswalk update to ensure accurate code mapping and proper Division of Financial Responsibility categorization for all injectable medications.
Health Net · Effective Sep 15, 2026High impact
26-828sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk
Effective September 15, 2026, Health Net/CalViva Health updated the Injectable Medication HCPCS/DOFR (Division of Financial Responsibility) Crosswalk with 10 new injectable medications, 6 new biosimilars, 4 new generic drugs, and 1,139 total updates/corrections to existing injectable medication codes and categorizations. Billing teams must obtain and implement the complete policy update to ensure accurate coding and proper financial responsibility assignment for all injectable medications.
Health Net · Effective Sep 15, 2026High impact
26-829sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk
Community Health Plan of Imperial Valley has updated the Injectable Medication HCPCS/DOFR Crosswalk effective September 15, 2026, with 1,459 total changes including 10 new injectable medications, 6 new biosimilars, 4 new generic drugs, 49 categorization corrections, 72 administrative changes, and 928 code description updates. Billing teams must verify all injectable medication codes against the updated crosswalk to ensure correct DOFR categorization and reimbursement.
Health Net · Effective Sep 1, 2026High impact
26-1190m Updates to Clinical Policies – September 2026
CalViva Health updated five clinical policies effective September 2026, including revised criteria for hospice services, obstetrical home care, durable medical equipment/orthotics/prosthetics, orthognathic surgery, and allogeneic hematopoietic progenitor cell therapy. Key billing-relevant changes include removal of two lower extremity prosthetic HCPCS codes (L8030, L8035) and AFO codes (L1933, L1952), clarified WCD approval increments, and updated DME coverage criteria. These changes apply to CalViva Health Medi-Cal members in Fresno, Kings, and Madera counties.
Health Net · Effective Sep 1, 2026High impact
26-1192m Updates to Clinical Policies – September 2026
Health Net updated five clinical policies effective September 2026, including changes to hospice services criteria, obstetrical home care visit requirements, durable medical equipment coverage (including removal of ankle-foot orthotics and lower extremity prosthetics codes, and addition of new device categories), orthognathic surgery measurement thresholds, and allogeneic hematopoietic progenitor cell therapy to include TREGZI. Billing and prior authorization workflows must be updated to reflect removed HCPCS codes, new approval increments for wearable cardioverter-defibrillators, and revised clinical criteria.
Health Net · Effective Aug 31, 2026High impact
26-1058 Provider Communication Posted Online and Operations Manual Updates for August 2026
Health Net California published multiple operational manual updates effective August 2026, with the most critical change being an update to 'Services Not Requiring Prior Authorization' (effective 8/31/26) that clarifies prior authorization exemptions for select hospice, behavioral health, maternal health, and preventive services. Additional updates address cognitive health assessment training removal, Medi-Cal prohibited entity payment guidelines, and member protections regarding public benefit form fees.
Health Net · Effective Aug 31, 2026High impact
26-1059 Provider Communication Posted Online and Operations Manual Updates for August 2026
This August 2026 policy update includes multiple operational changes affecting Medi-Cal providers in Fresno, Kings, and Madera counties. Key changes include: removal of cognitive health assessment training requirements (effective 8/4/26), updated claims payment guidelines for prohibited entities (effective 8/11/26), new guidance prohibiting member charges for public benefit forms (effective 8/21/26), and clarification of services not requiring prior authorization including hospice, behavioral health, maternal health, and preventive services (effective 8/31/26).
Health Net · Effective Aug 14, 2026High impact
26-773 IONM Billing Requirements Change, Effective August 14, 2026
Health Net is implementing new IONM billing requirements effective August 14, 2026, that align with CMS guidelines. Only specific CMS-recognized codes will be reimbursed, with strict unit limits and monitoring requirements that must be met to avoid claim denials.
Health Net · Effective Aug 1, 2026High impact
26-922 Prepare for 2026 Provider Access Surveys
Health Net California will conduct provider access surveys from August–December 2026 to assess appointment availability, after-hours access, and phone access. Participation is mandatory under California law and provider contracts. Failure to respond within 5 business days or meet access standards will result in claim payment delays, directory removal, and network participation impacts.
Health Net · Effective Aug 1, 2026High impact
26-924 Prepare for 2026 Provider Access Surveys
HealthNet California will conduct provider access surveys from August–December 2026 to assess appointment availability, after-hours access, and phone access. Participation is mandatory under California law and provider contracts. Failure to respond within 5 business days or meet access standards will result in claim payment delays, directory removal, and corrective action plans.
Health Net · Effective Aug 1, 2026High impact
26-923 Prepare for 2026 Provider Access Surveys
HealthNet California will conduct mandatory provider access surveys from August–December 2026 to assess appointment availability, after-hours access, and phone accessibility. Providers must respond within 5 business days of survey requests from Sutherland or face claim payment delays, directory removal, and corrective action plans. This is a compliance requirement under California law and provider contracts.
Health Net · Effective Aug 1, 2026High impact
26-809 New Requirement: Submit Medi-Cal Provider Onboarding Training Attestation Online
Effective August 1, 2026, all new Medi-Cal providers must complete onboarding training and submit an online attestation form through Health Net. Paper attestations will no longer be accepted. Failure to submit the online attestation may delay contract activation and result in regulatory compliance findings.
Health Net · Effective Aug 1, 2026High impact
26-810 New Requirement: Submit Medi-Cal Provider Onboarding Training Attestation Online
Effective August 1, 2026, Medi-Cal requires all new providers to complete onboarding training and submit an online attestation form instead of paper attestations. All new providers joining under a Medi-Cal agreement in Fresno, Kings, and Madera counties must complete training within 30 days of contract activation and submit the attestation online to avoid contract activation delays and regulatory compliance issues.
Health Net · Effective Aug 1, 2026High impact
26-811 New Requirement: Submit Medi-Cal Provider Onboarding Training Attestation Online
Effective August 1, 2026, all new Medi-Cal providers must complete onboarding training and submit an online attestation form (paper attestations are no longer accepted). Attestations must be submitted to confirm training completion prior to or within 30 days of contract activation. Failure to submit attestations will delay provider contract activation and may result in regulatory compliance findings.

Payer news

Network, contract and program news from the payers we track.

Health Net · Feb 25, 2026Payer news
26-277 CHPIV Medi-Cal Member ID Card Logo Update Delayed
The rollout of new CHPIV Medi-Cal member ID cards with updated logos has been delayed from the originally scheduled February 13, 2026 date.
Health Net · Feb 4, 2026Payer news
26-096 New CHPIV Logo for Medi-Cal Line of Business
Health Net California is introducing a new CHPIV logo specifically for Medi-Cal line of business to distinguish it from D-SNP programs.
Health Net · Nov 25, 2025Payer news
25-1233m 2024 Provider Access Survey Results
HealthNet California has released their 2024 Provider Access Survey Results tracking year-over-year performance in timely appointments and after-hours care.
Health Net · Nov 24, 2025Payer news
25-1241 Strengthen Patient Safety at Your Hospital With Expert-Led Support and Proven Tools
Health Net is promoting hospital patient safety improvement programs and resources, including expert-led support through HSAG's QIN-QIO program, data analytics tools, and recognition opportunities for high-performing hospitals.
Health Net · Oct 31, 2025Payer news
25-1120m 2024 Provider Access Survey Results
HealthNet California has released their 2024 Provider Access Survey Results tracking year-over-year performance in timely appointments and after-hours care.
Health Net · Oct 23, 2025Payer news
25-1083 Smarter Prescribing Starts Here: Lower Drug Costs with Gemini Health
Health Net is partnering with Gemini Health to provide real-time prescription cost insights directly within providers' EHR systems starting early November 2025.

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26-1071 Post-Decision Peer-to-Peer Reviews No Longer Available as a Method to Challenge Inpatient and Post-Acute Care Determinations

26-1061sum Summary Update: 3rd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk

26-1062sum Summary Update: 3rd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk

26-1060sum Summary Update: 3rd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk

26-1291 2027 Medicare Advantage and Special Needs Plan Updates: What You Need to Know

26-1008a Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFS

26-1008 Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFS

26-1009 Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFS

26-1010 Prepare for Unsatisfactory Immigration Status Member Transitions to Medi-Cal FFS

26-989 Changes to Community Supports Services, Effective January 1, 2027

26-991 Changes to Community Supports Services, Effective January 1, 2027

26-990 Changes to Community Supports Services, Effective January 1, 2027

26-1187 CMS Changes to Medicare Advantage Risk Score Calculations

26-1317 Transition to InterQual Clinical Review Criteria

26-1170 Changes to Behavioral Health Peer-to-Peer Reviews

26-1171 Changes to Behavioral Health Peer-to-Peer Reviews

26-1172 Changes to Behavioral Health Peer-to-Peer Reviews

26-1201 Updates to Prior Authorization Requirements

26-282m New State-Mandated Chaperone Requirements for Sensitive Ultrasound Exams Start January 1, 2027

26-281m New State-Mandated Chaperone Requirements for Sensitive Ultrasound Exams Start January 1, 2027

26-283m New State-Mandated Chaperone Requirements for Sensitive Ultrasound Exams Start January 1, 2027

26-1099 Health Net to Exit California Commercial Group Business Starting February 28, 2027

26-373 New California Credentialing Requirements Under AB 1041: Phased Implementation (2026-2028)

26-1204 California Children's Services Referral and Care Coordination Requirements

26-1205 California Children's Services Referral and Care Coordination Requirements

26-999 ECM Billing Limits Take Effect October 15, 2026

26-1000 ECM Billing Limits Take Effect October 15, 2026

26-1001 ECM Billing Limits Take Effect October 15, 2026

26-1186 Reimbursement Changes for Gender-Affirming Care, Effective October 13, 2026

26-1184 Reimbursement Changes for Gender-Affirming Care, Effective October 13, 2026

26-1185 Reimbursement Changes for Gender-Affirming Care, Effective October 13, 2026

26-1243 FQHCs and RHCs Must Use New Telehealth Billing Codes Beginning October 1, 2026

26-851 Definitive Drug Testing Billing Change, Effective October 1, 2026

26-891 Action Required: Comply with QMED 2.0 Encounter Submission Requirements

26-892 Action Required: Comply with QMED 2.0 Encounter Submission Requirements

26-893 Action Required: Comply with QMED 2.0 Encounter Submission Requirements

26-827sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk

26-828sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk

26-829sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk

26-1190m Updates to Clinical Policies – September 2026

26-1192m Updates to Clinical Policies – September 2026

26-1058 Provider Communication Posted Online and Operations Manual Updates for August 2026

26-1059 Provider Communication Posted Online and Operations Manual Updates for August 2026

26-773 IONM Billing Requirements Change, Effective August 14, 2026

26-922 Prepare for 2026 Provider Access Surveys

26-924 Prepare for 2026 Provider Access Surveys

26-923 Prepare for 2026 Provider Access Surveys

26-809 New Requirement: Submit Medi-Cal Provider Onboarding Training Attestation Online

26-810 New Requirement: Submit Medi-Cal Provider Onboarding Training Attestation Online

26-811 New Requirement: Submit Medi-Cal Provider Onboarding Training Attestation Online

Payer news

26-277 CHPIV Medi-Cal Member ID Card Logo Update Delayed ↗

26-096 New CHPIV Logo for Medi-Cal Line of Business ↗

25-1233m 2024 Provider Access Survey Results ↗

25-1241 Strengthen Patient Safety at Your Hospital With Expert-Led Support and Proven Tools ↗

25-1120m 2024 Provider Access Survey Results ↗

25-1083 Smarter Prescribing Starts Here: Lower Drug Costs with Gemini Health ↗

26-277 CHPIV Medi-Cal Member ID Card Logo Update Delayed

26-096 New CHPIV Logo for Medi-Cal Line of Business

25-1233m 2024 Provider Access Survey Results

25-1241 Strengthen Patient Safety at Your Hospital With Expert-Led Support and Proven Tools

25-1120m 2024 Provider Access Survey Results

25-1083 Smarter Prescribing Starts Here: Lower Drug Costs with Gemini Health