MedicaidPrior AuthMedium impact
23-365sum Summary Update: Know What Changes are Coming for Prior Authorizations
Health Net·CA · Pediatrics, Urology, Family Medicine +1 more·Prior Authorization
Effective date
Jul 1, 2023
We identified it
Jun 20, 2026
Summary
Health Net Medi-Cal is implementing several prior authorization changes effective July 1, 2023, including discontinuing prior auth reviews for incontinence supplies for members under 21, adding new outpatient pharmaceutical prior authorization requirements, and updating Coram infusion provider contact information.
Action Required
By July 1, 2023: Billing team must stop submitting prior authorization requests for incontinence supplies for Health Net Medi-Cal members under age 21 - direct CCS-eligible cases to California Children's Services instead. Update prior authorization workflows to include new outpatient pharmaceutical requirements per CMS HCPCS updates from January and April 2023. Immediately update contact information for Coram infusion services to phone 866-899-1661 and fax 866-843-3221.