MedicaidAdministrativeMedium impact
25-1183 Provider Communications Posted Online and Operations Manual Updates for October 2025
Health Net·CA·Prior Authorization
Effective date
Oct 31, 2025
We identified it
Jun 20, 2026
Summary
HealthNet California updated their Provider Operations Manual with several key changes including new guidance on non-benefit codes billing, updated prior authorization procedures for injectable medications, and revised hospice care documentation requirements. These changes primarily affect Medi-Cal providers in Fresno, Kings, and Madera counties.
Action Required
By November 1, 2025: Billing team should review the updated Billing and Authorization Procedures for Non-Benefit Codes document to understand DHCS policy on non-benefit codes and how it affects claims processing. Update prior authorization submission procedures for injectable medications based on line of business requirements. For hospice providers: ensure documentation is submitted within five calendar days of hospice election and reference the new Hospice Services Documentation Guide.