MedicaidPrior AuthHigh impact
24-544 Prior Authorization Extensions for All Services, Including DME, Ends June 30, 2024
Health Net·CA·Prior Authorization
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
Effective July 1, 2024, prior authorization approval durations for all services including durable medical equipment (DME) will revert from 6 months back to the pre-pandemic standard of 3 months. This applies to all CalViva Health Medi-Cal plans in Fresno, Kings, and Madera counties.
Action Required
By July 1, 2024: Billing team must update prior authorization tracking systems to reflect new 3-month approval durations instead of 6 months for all services and DME. Staff must monitor authorization expiration dates more frequently and submit renewal requests earlier to avoid claim denials. Update workflow reminders to check authorization status at 2.5 months instead of 5.5 months.