CommercialPrior AuthHigh impact
23-193m Site of Care Optimization for Therapeutic Infusions - 1st Quarter 2023
Health Net·CA · Rheumatology, Oncology, Hematology +6 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net has partnered with Coram CVS Specialty Infusion Services as the preferred provider for site of care optimization for therapeutic infusions, allowing Commercial and Exchange members to receive eligible infusion therapies at home or ambulatory infusion suites instead of hospitals. The policy covers a comprehensive list of infusion medications across multiple therapeutic areas including autoimmune disorders, immune deficiencies, and rare diseases.
Action Required
Immediately: Billing team must identify patients receiving any of the listed infusion medications and coordinate with Coram CVS Specialty Infusion Services when Health Net has financial responsibility. Check the Health Net Injectable Medication HCPCS/DOFR Crosswalk to determine financial responsibility between Health Net and PPGs. For Health Net responsibility cases, contact Coram directly for prior authorization and scheduling rather than billing for hospital-based infusions.