MedicaidAdministrativeMedium impact
25-520 Help Ensure Medi-Cal Members Get the ECM and CS Services They Need
Health Net·CA·Prior Authorization
Effective date
Jul 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net is implementing new closed-loop referral requirements for Medi-Cal Enhanced Care Management (ECM) and Community Supports (CS) services, requiring providers to track referrals through completion and submit monthly data files by the 5th of each month. Electronic communication methods will be mandatory, with fax only allowed by mutual agreement.
Action Required
By July 1, 2025: Establish process to submit Return Transmission Files via SFTP to Health Net by the 5th of each month for all ECM and CS referrals. Update referral workflows to use electronic methods (Provider Portal or Findhelp platform) instead of fax unless mutually agreed upon. Train staff on closed-loop referral tracking to ensure 90-day resolution timeframes are met. Set up monthly reporting process to include all assigned members with updated status information.