Medicare AdvantagePrior AuthHigh impact
24-341 Follow These Guidelines When Requesting a Peer-to-Peer Review With a Medical Director to Discuss An Adverse Determination
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net California has updated guidelines for requesting peer-to-peer reviews with medical directors after adverse prior authorization determinations. The policy clarifies time limits (5 business days), exclusions (no P2P after appeals are filed or post-discharge), and provides specific phone numbers and required information for different plan types.
Action Required
Immediately: Update prior authorization denial response procedures to include peer-to-peer review option within 5 business days. Train staff on exclusions (no P2P after appeals filed or post-discharge for concurrent reviews). Add phone numbers to quick reference: 818-676-7371 for Individual/Family, Employer Group, and Medicare Advantage plans; 818-676-5503 for Medi-Cal. Ensure staff collect required information: member name, DOB, case number, medical director name, nurse name, and member ID before calling.