MedicaidPrior AuthMedium impact
21-443 Know the Requirements for Prior Authorization Requests
Health Net·CA·Prior Authorization
Effective date
Aug 1, 2021
We identified it
Jun 20, 2026
Summary
CalViva Health (Medi-Cal) now requires complete prior authorization requests with all required information including diagnosis codes, procedure codes, NPIs, TINs, and service dates. Starting August 1, 2021, incomplete requests will be faxed back for missing information rather than processed.
Action Required
Immediately: Billing team must verify all prior authorization requests include diagnosis code, procedure code, requesting provider NPI and TIN, anticipated service date, and servicing provider NPI and TIN before faxing to CalViva Health. Use provided checklist to prevent requests being returned. Staff must also verify prior auth is required using Code Checker Tool before submitting to avoid unnecessary requests.