MedicaidPrior AuthMedium impact
24-453 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 posted April 2024 provider communications and operations manual updates including new peer-to-peer review guidelines and SDOH coding clarifications. Key change: providers now have only 5 business days after an adverse prior authorization determination to request a peer-to-peer review.
Action Required
Immediately: Update prior authorization denial workflow to ensure peer-to-peer review requests are submitted within 5 business days of adverse determinations. Train staff on new timeline requirements and implement tracking system for PA denials. Review SDOH Z-code usage on claims to prevent denials per 4/22/24 guidance.