MedicaidPrior AuthHigh impact
24-1318sum 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
CalViva Health has implemented new prior authorization requirements effective March 1, 2025, for outpatient pharmaceuticals submitted under medical benefit and new CMS-issued CPT/HCPCS codes from October 1, 2024. 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 the complete policy update 24-1318 to identify specific drugs and codes requiring prior authorization. Download and implement the new supplemental form from the Prior Authorization web page in the Medi-Cal Provider Library for requests involving more than four procedure codes. Update billing system workflows to trigger prior authorization requirements for affected pharmaceuticals and CMS codes. Contact CalViva Health at 888-893-1569 for questions or 844-966-0298 for Behavioral Health providers.