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23-1024m Reminder: Sign This Form for NEMT for Medi-Cal Members

Health Net·CA·Provider News
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply

Summary

Health Net California requires providers to use a specific Physician Certification Statement form when certifying medical necessity for Non-Emergency Medical Transportation (NEMT) services for Medi-Cal members. This is a reminder about an existing requirement with an updated form that must be downloaded and used.

Action Required

Action needed
Immediately: Download the updated Physician Certification Statement form from the Health Net provider portal. Make copies and ensure all providers use this specific form when certifying medical necessity for NEMT services for Medi-Cal patients. Update office procedures to include this form in NEMT authorization workflows.