CommercialPrior AuthHigh impact
21-441 Know the Requirements for Prior Authorization Requests
Health Net·CA·Prior Authorization
Effective date
Aug 1, 2021
We identified it
Jun 20, 2026
Summary
Health Net California is now returning incomplete prior authorization fax requests starting August 1, 2021, with specific information missing clearly identified. All prior auth requests must include 7 required elements including diagnosis codes, procedure codes, provider NPIs/TINs, and service dates or they will be faxed back for completion.
Action Required
Immediately: Billing team and providers must use the mandatory 7-item checklist for all prior authorization fax requests: diagnosis code, procedure code, requesting provider NPI, requesting provider TIN, anticipated service start/admission date, servicing provider NPI, and servicing provider TIN. Update prior auth workflows to include verification of all items before faxing. Incomplete requests will be returned, delaying authorization processing.