MedicaidPrior AuthMedium impact
21-781 Transplant Benefit for Medi-Cal Members
Health Net·CA · General Surgery, Ophthalmology, Nephrology +2 more·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Health Net will now cover major organ transplants and corneal transplants for Medi-Cal members ages 21 and over, requiring prior authorization and mandating that all participating physician groups submit requests directly to the health plan rather than handling through delegation.
Action Required
Immediately: Billing team must ensure all major organ transplant and corneal transplant requests for Medi-Cal members ages 21+ are submitted to Health Net for prior authorization via fax to 833-769-1141. Update workflows to bypass PPG delegation for these services. Verify all transplant procedures are performed at Medi-Cal-approved Centers of Excellence. Claims without prior authorization will be denied.