CommercialPrior AuthMedium impact
25-471m Medical Policies - April 2025
Health Net·CA · Transplant Surgery, Wound Care, Emergency Medicine +3 more·Prior Authorization
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net updated 5 medical policies effective April 2025, including changes to air ambulance coverage, behavioral health documentation requirements, cardiac device procedures, varicose vein treatments, and wound care products. Most changes involve updated prior authorization criteria and documentation requirements.
Action Required
By April 1, 2025: Review and update prior authorization workflows for the 5 affected policy areas. Billing team must ensure documentation requirements are met for behavioral health services (CP.BH.500), cardiac procedures (CP.MP.147), varicose vein treatments (CP.MP.146), wound care products (CP.MP.185), and transplant services (CP.MP.247). Update encounter forms and EMR templates to reflect new criteria. Contact Health Net Provider Services at appropriate phone numbers if clarification needed on specific requirements.