MedicaidAdministrativeMedium impact
25-1182 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
Health Net California posted October 2025 provider communications and operations manual updates including new guidance on non-benefit codes, prior authorization procedures for injectables, and hospice documentation requirements. Several key billing and authorization processes were clarified with immediate effective dates.
Action Required
Immediately: Review new Billing and Authorization Procedures for Non-Benefit Codes document to understand DHCS policy on claims, prior authorization and dispute processes. Update prior authorization submission procedures for injectable medications based on line of business. For hospice cases, ensure required documentation is submitted within 5 calendar days of hospice election and reference the new Hospice Services Documentation Guide.