MedicaidPrior AuthMedium impact
25-999 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency
Health Net·CA · Endocrinology, Psychiatry·Prior Authorization
Effective date
Dec 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net is streamlining prior authorization requirements effective December 1, 2025, removing PA requirements for some services (oxygen, genetic testing, behavioral analysis, enteral nutrition, respite services) while maintaining PA requirements for others (incontinence supplies, certain pharmaceuticals). This applies specifically to Medi-Cal LA-DHS participating provider groups.
Action Required
By December 1, 2025: Billing team must update prior authorization requirements in billing system - remove PA requirements for oxygen (E0441), genetic testing (81244, 81331), applied behavioral analysis (S5111), enteral nutrition products (S9342, S9343), and respite services (S9125). Maintain PA requirements for incontinence supplies (T4521-T4524) and specified pharmaceuticals (J3420, J1944, J2426, J2427). Update encounter forms and staff training accordingly.