CommercialPrior AuthHigh impact
24-1315sum Summary Update: New Prior Authorization Changes, Effective March 1, 2025
Health Net·CA·Prior Authorization
Effective date
Mar 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net is implementing new prior authorization requirements for outpatient pharmaceutical medications covered under medical benefits, effective March 1, 2025. New CPT and HCPCS codes from CMS also require prior authorization as of October 1, 2024, and a supplemental form is now required for authorization requests involving more than four procedure codes.
Action Required
By March 1, 2025: Billing team must review the complete policy update 24-1315 to identify specific medications and codes requiring prior authorization. Update billing system workflows to flag affected outpatient pharmaceutical claims for prior auth verification. Download and implement the new supplemental prior authorization form for requests with more than four procedure codes from the Health Net Provider Library. Train staff on new prior auth requirements to prevent claim denials.