CommercialPrior AuthHigh impact
21-440 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 has implemented stricter prior authorization submission requirements effective August 1, 2021. All prior auth requests must include 7 required data elements (diagnosis code, procedure code, provider NPI/TIN, service dates, etc.) or they will be faxed back for resubmission, which will delay processing.
Action Required
Immediately: Billing team must update prior authorization workflow to include mandatory checklist verification before faxing requests to Health Net. Ensure all requests include: diagnosis code, procedure code, requesting provider NPI and TIN, anticipated service start date, servicing provider NPI and TIN. Train staff that incomplete requests will be returned starting August 1, 2021, causing processing delays. Avoid duplicate submissions and only mark requests as urgent if service is within 10 days.