MedicaidPrior AuthMedium impact
25-945 Provider Communications Posted Online and Operations Manual Updates for August 2025
Health Net·CA·Prior Authorization
Effective date
Aug 29, 2025
We identified it
Jun 20, 2026
Summary
HealthNet California has updated multiple provider communications and operations manual sections for August 2025, including a new enhanced Prescription Drug Prior Authorization form with updated contact information and clarifications on emergency claims billing following CMS guidelines when DHCS is silent.
Action Required
Immediately: Update to the new Prescription Drug Prior Authorization or Step Therapy Exception Request form (effective 8/19/25 and 8/26/25) which includes enhanced contact information for different prior authorization types. Billing teams should access the updated form from the Provider Library and ensure all prescription prior auth requests use the new format. Review emergency-related claims procedures to follow CMS coding and billing guides when DHCS guidelines are silent (effective 8/6/25).