MedicaidPrior AuthMedium impact
22-535 What News Is Online for June 2022
Health Net·CA · Oncology, Primary Care·Prior Authorization
Effective date
Jul 1, 2022
We identified it
Jun 20, 2026
Summary
This policy update provides a summary of three changes for Medi-Cal providers in Fresno, Kings, and Madera counties: expanded coverage for blood pressure monitors under Medi-Cal Rx, elimination of prior authorization for biomarker testing in advanced/metastatic cancer patients effective July 1, 2022, and introduction of a new Enhanced Care Management invoice claim form.
Action Required
By July 1, 2022: Stop requiring prior authorization for biomarker testing claims for patients with advanced or metastatic cancer. Update billing system to remove prior auth requirements for these specific conditions. Begin using the new Enhanced Care Management (ECM) and Community Supports Invoice Claim Form for ECM-related services. Update billing procedures to include blood pressure monitors as covered pharmacy-billed items under Medi-Cal Rx effective June 1, 2022.