Medicare AdvantagePrior AuthMedium impact
25-943 Provider Communications Posted Online and Operations Manual Updates for August 2025
Health Net·CA·Prior Authorization
Effective date
Aug 19, 2025
We identified it
Jun 20, 2026
Summary
Health Net California published August 2025 provider communications and operations manual updates, including a new prescription drug prior authorization form with line-specific contact information, updated emergency claim billing guidelines following CMS standards, and new federal restrictions on Medi-Cal payments to certain reproductive health nonprofits.
Action Required
Immediately: Download and begin using the updated Prescription Drug Prior Authorization or Step Therapy Exception Request form with new cover page containing line of business-specific contact information. Update pharmacy services fax numbers in billing system. Review emergency-related claims procedures to ensure compliance with CMS coding and billing guides when DHCS guidelines are silent. For Medi-Cal providers: Review new federal restrictions on payments to reproductive health nonprofits.