Medicare AdvantagePrior AuthMedium impact
24-275m Medical Policies - February 2024
Health Net·CA · Sleep Medicine, Pulmonology·Prior Authorization
Effective date
May 1, 2024
We identified it
Jun 20, 2026
Summary
Centene has developed a new prior authorization policy for facility-based sleep studies for obstructive sleep apnea, effective May 1, 2024. This policy affects Medicare Advantage plans and requires providers to obtain prior authorization for covered sleep study procedures.
Action Required
By May 1, 2024: Billing team must update prior authorization requirements for facility-based sleep studies for obstructive sleep apnea in billing system. Contact Health Net Provider Services Center at 844-966-0298 or through the provider portal to obtain complete policy details including specific CPT codes and authorization procedures. Failure to obtain prior authorization may result in claim denials.