Medicare AdvantagePrior AuthMedium impact
24-176 Provider Operations Manual Updates for January 2024
Health Net·CA · Palliative Care·Prior Authorization
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Health Net California updated multiple provider operations manual sections in January 2024, including new prior authorization requirements for palliative care services, changes to pharmacy benefit managers from CVS to Express Scripts, and updated claims submission addresses for behavioral health providers in specific counties.
Action Required
Immediately: Update prior authorization forms - use Outpatient Medi-Cal Prior Authorization Form for Medi-Cal palliative care services and Care Management Referral Form for HMO/PPO palliative care services with all mandatory information completed. Update pharmacy references from CVS to Express Scripts for Ambetter and Wellcare plans. For behavioral health providers in Amador, Los Angeles, Calaveras, Sacramento, Inyo, Mono, San Joaquin, Stanislaus, Tuolumne, and Tulare counties: update claims submission address and payer ID information in billing systems.