MedicaidPrior AuthHigh impact
25-325sum 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
Community Health Plan of Imperial Valley has updated their prior authorization process with new CPT and HCPCS codes requiring prior auth effective January 1, 2025, with additional changes coming April 1 and June 15, 2025. Providers can submit prior auth requests via fax, online portal, or phone.
Action Required
Immediately: Review the updated CHPIV Prior Authorization List in the Provider Library to identify new CPT and HCPCS codes requiring prior auth as of January 1, 2025. By April 1, 2025: Update billing system and encounter forms for additional procedures requiring prior auth per upcoming CMS codes (details in forthcoming provider update). By June 15, 2025: Remove codes no longer requiring prior auth from billing system workflows. Ensure staff know three submission options: fax to 800-743-1655, online provider portal, or phone 833-236-4141.