MedicaidPrior AuthHigh impact
25-523sum Summary Update: Prior Authorization Changes, Effective April 1, 2025, through August 1, 2025
Health Net·CA·Prior Authorization
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
Community Health Plan of Imperial Valley (CHPIV) is implementing prior authorization changes for Medi-Cal services with new CPT and HCPCS codes requiring prior auth starting April 1, 2025, with additional changes on July 1 and August 1, 2025. The policy includes both additions of new prior authorization requirements and removals of existing ones throughout the implementation period.
Action Required
By April 1, 2025: Billing team must access the updated Medi-Cal Prior Authorization Requirements through the Provider Library or CHPIV Prior Authorization List to identify specific CPT and HCPCS codes requiring prior authorization. Update billing system workflows to flag these codes for prior auth verification before service delivery. Monitor for additional changes effective July 1 and August 1, 2025. Contact CHPIV at 833-236-4141 for questions or Behavioral Health providers call 844-966-0298. Claims submitted without required prior authorization will be denied.