MedicaidPrior AuthMedium impact
24-575 Provider Communications Posted Online and Operations Manual Updates for May 2024
Health Net·CA·Prior Authorization
Effective date
May 6, 2024
We identified it
Jun 20, 2026
Summary
CalViva Health updated their Provider Operations Manual to exempt American Indian members from prior authorization requirements for certain services, effective May 6, 2024. This applies to Medi-Cal managed care in Fresno, Kings, and Madera counties based on new state guidance.
Action Required
Immediately: Billing team must update prior authorization workflows to identify American Indian members and bypass prior auth requirements for applicable services in Medi-Cal. Update billing system flags for members in Fresno, Kings, and Madera counties. Review Services Not Requiring Prior Authorization document in Provider Library for complete list of exempt services.