MedicaidCoverageMedium impact
20-1031 Reminder: Refer Patients for a Second Opinion When Needed
Health Net·CA·Provider News
We identified it
Jun 20, 2026
Summary
CalViva Health (Medi-Cal in Fresno, Kings and Madera counties) reminds providers that members can receive second opinion consults for questioned surgical procedures, diagnoses threatening major damage, unclear clinical signs, or non-improving treatment plans. All second opinion referrals must be authorized by the PPG or PCP to be covered benefits.
Action Required
Immediately: Providers and billing team must ensure all second opinion consults are authorized by the participating physician group (PPG) or primary care physician (PCP) before scheduling. Update referral workflows to require separate approvals for additional tests, lab, or x-ray services beyond the consult. Ensure results are sent back to PPG or PCP for care coordination. Failure to obtain proper authorization will result in coverage denials.