All PlansAdministrativeMedium impact
22-273 Complete Required Training to Ensure Proper Medical Necessity Determination
Health Net·CA · Endocrinology, Plastic Surgery, Urology +2 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net requires staff who perform utilization review for gender affirming procedures to complete mandatory WPATH training and pass an Inter-Rater Reliability test within 12 months. This applies to participating physician groups (PPGs) delegated for utilization management who make medical necessity determinations using WPATH criteria.
Action Required
Within 12 months of enrollment: Staff responsible for medical necessity decisions on gender affirming procedures must complete WPATH training (recorded didactic sessions and livestreamed panel) and pass IRR testing. PPGs must ensure compliance as this will be validated during annual utilization management audits. For new staff going forward, training must be completed before they can independently review these requests. Contact Health Net to request training for new staff with their name, title, and email address.