Medicare AdvantagePrior AuthHigh impact
21-784 Prior Authorization! Find Out What’s New or Changing
Health Net·Oncology, Hematology, Cardiology +4 more·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Wellcare By Health Net is implementing new prior authorization requirements for Medicare Advantage HMO plans effective January 1, 2022, including multiple new Part B medications, behavioral health services like TMS, and medical devices, while removing PA requirements for wheelchairs and wound vacuums.
Action Required
By January 1, 2022: Billing team must update prior authorization requirements for all listed Part B medication codes (C9075-Q2054, J0882, J9144, J9358, Q4081), behavioral health TMS procedures, and transcatheter wireless pulmonary artery pressure implantation. Remove PA requirements for wheelchairs/accessories and wound vacuum equipment. Update billing system rules and staff training to prevent claim denials for non-compliant submissions.