MedicaidPrior AuthMedium impact
25-248 Refer Members to In-Network Providers to Minimize Out-of-Pocket Costs
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health Medi-Cal now requires providers to prioritize in-network referrals and obtain prior authorization for out-of-network referrals except in emergencies or when legally required. Out-of-network referrals without proper authorization will not be reimbursed.
Action Required
Immediately: All providers must use the Find a Provider tool before making referrals to verify network status. Contact Plan Provider Services at 888-893-1569 (Medi-Cal) or 844-966-0298 (Behavioral Health) to obtain prior authorization for any necessary out-of-network referrals. Update referral workflows to prioritize in-network providers and document authorization for exceptions.