MedicaidDocumentationMedium impact
23-1023m Reminder: Sign This Form for NEMT for Medi-Cal Members
Health Net·CA·Provider News
We identified it
Jun 20, 2026
Summary
Health Net California is reminding providers to use the Physician Certification Statement form for Non-Emergency Medical Transportation (NEMT) services for Medi-Cal members. Providers must make copies of the attached form and complete it when certifying medical necessity for patient transportation.
Action Required
Immediately: Download and make copies of the Physician Certification Statement form from the provider portal. Providers must complete this form when certifying medical necessity for NEMT services for Medi-Cal patients. Ensure all physicians, PPGs, hospitals, ancillary providers, CS providers, and ECM providers have access to the form. Failure to properly complete certification may result in NEMT service denials.