MedicaidPrior AuthHigh impact
25-1080 Understanding Medi-Cal Non-Benefit Billing Codes: What Providers Need to Know
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net Medi-Cal has clarified that 'non-benefit' billing codes don't mean services are excluded from coverage, but rather require case-by-case evaluation and potentially prior authorization for reimbursement. Providers must check prior authorization requirements and obtain approval before rendering services when required to avoid claim denials.
Action Required
Immediately: Billing team must update workflow to check Health Net's prior authorization requirements list before submitting claims for any codes listed as 'non-benefit' in the Medi-Cal Treatment Authorization Request (TAR) and Non-Benefit list. Providers must obtain prior authorization when required before rendering services. When submitting claims for approved services, clearly indicate the authorization number. If claims are denied, initiate dispute through Health Net's provider dispute resolution process. Access updated provider operations manuals in the Provider Library on Health Net's provider portal.