Medicare AdvantageAdministrativeMedium impact
24-451 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 posted April 2024 provider communications including new peer-to-peer review guidelines (5 business days to request after adverse prior auth determination), requirements for valid National Drug Codes on claims, and updates to SDOH Z codes usage. Payment integrity policies have been moved from the operations manual to the Health Net provider website.
Action Required
Immediately: Billing team must note that peer-to-peer reviews for adverse prior authorization determinations must be requested within 5 business days of issuance. Ensure all claims with drug codes include complete National Drug Code information to prevent payment delays. Update staff on proper use of SDOH Z codes on Medi-Cal claims. Access updated payment policies at the new Health Net provider website location instead of operations manual.