Traditional MedicarePrior AuthHigh impact
24-476m Medicare Prior Authorization Changes for Part B Medications
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
HealthNet California has implemented new CMS prior authorization requirements for Medicare Part B medications with specific codes effective January 1, 2024 and April 1, 2024. Healthcare providers must now obtain prior authorization for certain Part B medications that previously did not require approval.
Action Required
Immediately: Billing team must download the Provider Update PDF from HealthNet California's provider library to identify the specific CMS codes requiring prior authorization. Update billing system workflows to flag Part B medication codes effective January 1, 2024 and April 1, 2024 for prior authorization requirements. Train staff on new prior auth process to prevent claim denials for affected medications.