MedicaidPrior AuthMedium impact
24-804 Medical Medication PA Updates and New Requirements
Health Net·CA·Prior Authorization
Effective date
Jul 29, 2024
We identified it
Jun 20, 2026
Summary
HealthNet California has updated prior authorization requirements for medical medications affecting Medi-Cal patients in Fresno, Kings, and Madera counties. This policy change introduces new PA requirements and updates existing ones for various medical medications.
Action Required
Immediately: Billing team and providers must download and review the Provider Update PDF from HealthNet's provider library to identify specific medications requiring new prior authorization. Update workflows to ensure PA requests are submitted for affected medications before prescribing or billing. Failure to obtain required prior authorization will result in claim denials for Medi-Cal patients in the specified counties.