Medicare AdvantagePrior AuthHigh impact
22-595 Prepare for Utilization Management Changes
Health Net·CA·Prior Authorization
Effective date
Oct 1, 2022
We identified it
Jun 20, 2026
Summary
Wellcare By Health Net is updating peer-to-peer review timelines (effective October 1, 2022) and extending elective inpatient prior authorization validity from current timeframe to 60 days (effective November 1, 2022). Authorization numbers for elective admissions will change from IP to OP prefix, with IP numbers issued only after admission notification.
Action Required
Immediately: Update workflows for Wellcare By Health Net patients - (1) Elective inpatient prior authorizations are now valid for 60 days instead of previous timeframe, (2) Expect authorization numbers starting with 'OP' prefix for elective admissions, (3) Notify plan within one business day of admission to receive new 'IP' prefixed authorization number, (4) Update peer-to-peer review request procedures to allow only up to 2 business days after denial notice or discharge. Failure to provide timely admission notification may result in denial of payment.