MedicaidDocumentationMedium impact
25-1137m Submit Medical Records for HEDISReview Starting January 2, 2026
Health Net·CA·Prior Authorization
Effective date
Jan 2, 2026
We identified it
Jun 20, 2026
Summary
Starting January 2, 2026, Health Net/CalViva Health will begin requesting medical records from randomly selected physicians and PPGs for HEDIS quality review through May 30, 2026. Providers must submit requested records within 7 business days using the no-cost Datafied service or complete a Certificate of No Record if applicable.
Action Required
Before January 2, 2026: Medical records team must establish process to respond to HEDIS requests within 7 business days. Ensure contact information is current with Health Net. Train staff on using Datafied service (714-666-0951) and completing Certificate of No Record forms when patients are not seen during requested timeframes. Failure to respond timely may result in follow-up actions.