Medicare AdvantagePrior AuthMedium impact
24-572 Provider Communications Posted Online and Operations Manual Updates for May 2024
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
This policy summarizes May 2024 provider communications and operations manual updates, including new Medicare prior authorization requirements for Part B medications, expanded services not requiring prior authorization for American Indian members, and support for expanded nurse practitioner scope of practice.
Action Required
Immediately: Review the updated Services Not Requiring Prior Authorization document for American Indian members effective 5/6/24. Billing team should verify prior authorization requirements for Medicare Part B medications using the new HCPCS codes effective January 1 and April 1, 2024. Update billing workflows to reflect that certain services for American Indian Medi-Cal members no longer require prior authorization per All Plan Letter 24-002.