MedicaidPrior AuthHigh impact
24-1316sum 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 Medi-Cal has updated prior authorization requirements for outpatient pharmaceuticals and added new CPT/HCPCS codes requiring prior auth, effective March 1, 2025. A new supplemental form is now required when authorization requests involve more than four procedure codes.
Action Required
Before March 1, 2025: Billing team must review complete policy update 24-1316 to identify specific drugs and codes requiring new prior authorization. Download and implement the new supplemental form from Health Net's Prior Authorization web page for requests involving more than four procedure codes. Update billing system workflows to flag affected pharmaceuticals and procedures for prior auth verification. Contact Health Net at 800-675-6110 for clarification on specific requirements.