MedicaidPrior AuthHigh impact
25-324sum Summary Update: Updates to the Prior Authorization Process, and New and Upcoming Requirements Changes
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
CalViva Health has updated their prior authorization process with new requirements for specific CPT and HCPCS codes effective January 1, 2025, with additional changes rolling out on April 1 and June 15, 2025. The policy clarifies three submission methods (fax, online portal, phone) and includes immediate changes, additions, and removals of prior authorization requirements.
Action Required
Immediately: Review the complete policy document 25-324 to identify specific CPT and HCPCS codes requiring prior authorization. Update billing system to flag new codes requiring prior auth effective January 1, 2025. Monitor for forthcoming provider updates detailing April 1, 2025 changes for additional procedures and DME. Train staff on three submission methods: fax to 800-743-1655, online portal, or phone 888-893-1569. Access updated Prior Authorization Requirements in Provider Library under Medi-Cal section.