CommercialPrior AuthHigh impact
21-337m Prior Authorization Reminder for Outpatient Therapy Visits
Health Net·CA · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab) +2 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net now requires prior authorization for physical therapy, occupational therapy, and speech therapy visits after 12 combined visits for fee-for-service providers. The first 12 visits do not require authorization.
Action Required
Immediately: Billing team must update system to track combined therapy visits and require prior authorization after 12 visits for Health Net FFS patients. Update encounter forms to alert providers when approaching visit limit. Configure billing software to flag therapy claims requiring prior auth. Access PA requirements at Health Net provider website under 'Services Requiring Prior Authorization'.