MedicaidAdministrativeMedium impact
25-537 Provider Communications Posted Online and Operations Manual Updates for May 2025
Health Net·CA·Provider News
Effective date
May 1, 2025
We identified it
Jun 20, 2026
Summary
HealthNet California published May 2025 provider communications and operations manual updates covering biosimilar medication preferences, medical policy changes, dental anesthesia fee responsibilities, and behavioral health resources. Key updates include removal of the Fit Families for Life Program, new blood pressure monitor ordering procedures through Western Drugs, updated transplant center lists, and expanded AB936 maternal mental health screening requirements for Medi-Cal members.
Action Required
By June 1, 2025: Billing team should review the updated medical policies from April 2025 available in the Provider Library to ensure compliance with new medical necessity guidelines. Update staff on preferred biosimilar medications list for formulary compliance. For PPGs handling dental procedures, review anesthesia and facility fee responsibility charts from DHCS' All Plan Letter 23-028. Update blood pressure monitor ordering procedures to use Western Drugs as the preferred DME provider. Verify transplant center referrals against the updated Transplant Performance Center List.