MedicaidPrior AuthMedium impact
26-156 Provider Communications Posted Online and Operations Manual Updates for January 2026
Health Net·CA · Gastroenterology·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
This January 2026 policy update provides a comprehensive list of recent provider communications and operations manual changes, with the most significant billing impact being updated prior authorization timelines for enteral nutrition reduced to 7 calendar days for Medi-Cal and Medicare, effective 1/1/26. The update also includes new reimbursement timeline requirements and penalties for late claims processing based on recent legislation.
Action Required
Immediately: Review and update prior authorization request timelines for enteral nutrition to comply with new 7-day requirement for Medi-Cal and Medicare patients. Download updated Prior Authorization forms from the Provider Library Forms and References section. Update billing team workflows to accommodate new reimbursement timeline requirements and penalties per Assembly Bill 3275. Review updated Injectable Medication HCPCS crosswalk effective 1/8/26 for proper billing of injectable medications.