Medicare AdvantagePrior AuthMedium impact
24-1256 Provider Communications Posted Online and Operations Manual Updates for November 2024
Health Net·CA·Prior Authorization
Effective date
Nov 25, 2024
We identified it
Jun 20, 2026
Summary
HealthNet California published November 2024 operations manual updates including changes to D-SNP prior authorization requirements, interpreter services contact updates, and facility review standards. Most significantly, PPGs must now check both Medicare and Medi-Cal benefits before denying prior authorization requests for D-SNP members.
Action Required
Immediately: Billing team must update prior authorization workflow for D-SNP (Dual Special Needs Plan) members. Before denying any prior authorization as 'not a covered benefit', staff must verify coverage under BOTH Medicare and Medi-Cal benefits. Update prior authorization review procedures and train staff on new D-SNP requirements to avoid improper denials.