MedicaidPrior AuthMedium impact
21-779 Transplant Benefit for Medi-Cal Members
Health Net·CA · Nephrology, Cardiology, Gastroenterology +4 more·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Health Net will now cover major organ transplant (MOT) and corneal transplant benefits for Medi-Cal members ages 21 and over, requiring prior authorization for all transplant-related services. All participating physician groups must submit transplant requests directly to Health Net with no delegation allowed.
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 by faxing to Transplant Team at 833-769-1141. Include clinically relevant information for medical necessity review. For members under 21, continue submitting to California Children's Services (CCS) office first.