MedicaidPrior AuthMedium impact
23-367sum Summary Update: Know What Changes are Coming for Prior Authorizations
Health Net·CA · Sleep Medicine, Urology, Pediatrics·Prior Authorization
Effective date
Jul 1, 2023
We identified it
Jun 20, 2026
Summary
CalViva Health is making several prior authorization changes effective July 1, 2023: removing PA requirements for incontinence supplies for members under 21, adding new PA requirements for outpatient pharmaceuticals with new HCPCS codes, and eliminating PA requirements for home-based sleep studies. Contact information for preferred infusion provider Coram has also been updated.
Action Required
By July 1, 2023: Update billing system to remove prior authorization requirements for incontinence supplies for members under 21 and home-based sleep studies. Add PA requirements for new outpatient pharmaceuticals with HCPCS codes issued by CMS in January and April 2023. Update contact information for Coram infusion services to phone 866-899-1661 and fax 866-843-3221. Verify CCS eligibility for members under 21 before submitting incontinence supply requests.