Medicare AdvantagePrior AuthMedium impact
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Health Net·CA · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab)·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net reminds providers that prior authorization is required after 12 combined outpatient therapy visits (physical, occupational, and speech therapy) for Cal MediConnect members in Los Angeles and San Diego counties. Visits 1-12 do not require authorization.
Action Required
Immediately: Billing team must ensure prior authorization is obtained before scheduling visit #13 and beyond for any combination of physical, occupational, and speech therapy for Cal MediConnect members. Update scheduling system to track therapy visit counts and flag when approaching the 12-visit threshold. Contact Health Net at 1-855-464-3571 (LA County) or 1-855-464-3572 (San Diego County) for authorization requests.