CommercialPrior AuthMedium impact
23-364sum Summary Update: Know What Changes are Coming for Prior Authorizations
Health Net·CA · Sleep Medicine, Urology·Prior Authorization
Effective date
Jul 1, 2023
We identified it
Jun 20, 2026
Summary
Health Net has updated prior authorization requirements effective July 1, 2023, including eliminating PA requirements for incontinence supplies for Medi-Cal members under 21, adding new pharmaceutical PA requirements, and removing PA requirements for home-based sleep testing for Medi-Cal fee-for-service members.
Action Required
By July 1, 2023: Billing team must update prior authorization workflows to stop requiring PA for incontinence supplies for Medi-Cal members under age 21 and for home-based sleep testing for Medi-Cal fee-for-service members. Update system to require PA for new outpatient pharmaceuticals per CMS HCPCS codes effective January 1 and April 1, 2023. Update Coram infusion provider contact information: Phone 866-899-1661, Fax 866-843-3221. Review full policy document 23-364 for complete list of pharmaceutical PA changes.