MedicaidPrior AuthHigh impact
23-1159 Learn More About New Post-Stabilization Authorization Requirements
Health Net·CA · Emergency Medicine, Critical Care·Prior Authorization
Effective date
May 3, 2023
We identified it
Jun 20, 2026
Summary
CalViva Health (Health Net) has implemented new post-stabilization authorization requirements for emergency care. Providers must now request specific authorization for post-stabilization care within 30 minutes after patient stabilization, and the plan must respond within 30 minutes or the care is automatically authorized.
Action Required
Immediately: Hospital billing and clinical staff must establish new workflow for post-stabilization care requests. Contact CalViva Health's Hospital Notification Unit at 800-995-7890 option 2 within 30 minutes after patient stabilization. Document all requests including date, time, provider name/contact, clinical information, and plan representative responses. Note that general admission notifications do NOT satisfy this requirement - must specifically state patient is stabilized and requesting post-stabilization care authorization.