MedicaidDocumentationMedium impact
25-473m Medical Policies - April 2025
Health Net·CA · Emergency Medicine, Psychiatry, Cardiology +3 more·Prior Authorization
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
CalViva Health updated six medical policies for April 2025, including expanded air ambulance coverage to water ambulances, enhanced behavioral health documentation requirements, revised stroke prevention device criteria, updated varicose vein treatment requirements, new skin substitute criteria with preferred product lists, and additional transplant follow-up documentation requirements.
Action Required
By April 1, 2025: Billing team must review and update prior authorization workflows for air ambulance services (now including water ambulances), behavioral health treatment documentation, percutaneous left atrial appendage closure devices, sclerotherapy procedures, skin and soft tissue substitutes (verify preferred product list compliance), and transplant follow-up services. Contact CalViva Health at 888-893-1569 for questions or 844-966-0298 for behavioral health inquiries. Update EMR templates to reflect new documentation requirements.