MedicaidPrior AuthMedium impact
24-454 Provider Communications Posted Online and Operations Manual Updates for April 2024
Health Net·CA·Prior Authorization
Effective date
Apr 17, 2024
We identified it
Jun 20, 2026
Summary
Health Net has updated their Medi-Cal provider operations manual for April 2024 with two key changes: payment policies have been moved from the operations manual to a dedicated website section, and new peer-to-peer review request guidelines have been established requiring requests within 5 business days of adverse prior authorization determinations.
Action Required
Immediately: Update billing team workflows to access payment policies at the new Health Net provider website location instead of the operations manual. By next adverse prior authorization: Ensure all staff know they have only 5 business days after receiving an adverse prior authorization determination to request a peer-to-peer review. Update denial tracking procedures to flag this deadline.