CommercialPrior AuthHigh impact
23-1295 Sign a Conservative Treatment Form for Advanced Imaging Authorizations
Health Net·CA·Prior Authorization
Effective date
Jan 16, 2024
We identified it
Jun 20, 2026
Summary
Starting January 16, 2024, Health Net requires providers to submit a Conservative Treatment Form to NIA when requesting prior authorization for advanced imaging (CT, MRI, PET, etc.) for Commercial HMO, PPO, EPO, POS, HSP and Ambetter plans. This form must be completed and submitted before services are authorized to ensure approval.
Action Required
Immediately: Download Conservative Treatment Forms from NIA website. Update prior authorization workflow to require completion and submission of Conservative Treatment Form BEFORE requesting authorization for all advanced imaging (CT/CTA/CCTA, MPI, MRI/MRA, MUGA, PET scans) for Health Net Commercial HMO, PPO, EPO, POS, HSP and Ambetter members. Submit forms via NIA website upload or fax per NIA instructions. Failure to obtain proper authorization may result in claim denials.