Medicare AdvantagePrior AuthHigh impact
25-328sum Summary Update: Updates to the Prior Authorization Process and New Requirements, Effective January 1, 2025
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net California has updated their prior authorization process effective January 1, 2025, adding new CPT and HCPCS codes that require prior authorization per CMS requirements. The policy provides three submission options (fax, online portal, or phone) and directs providers to updated authorization lists in their Provider Library.
Action Required
By January 1, 2025: Billing team must access the Health Net Provider Library to review the updated Medicare - California Prior Authorization List for new CPT and HCPCS codes requiring prior auth. Update billing system flags for these new codes. Train staff on three submission methods: fax to 844-501-5713 using updated forms, online via secure provider portal, or phone at 800-929-9224. Failure to obtain required prior authorizations will result in claim denials.