MedicaidPrior AuthMedium impact
20-1030 Reminder: Refer Patients for a Second Opinion When Needed
Health Net·CA·Provider News
We identified it
Jun 20, 2026
Summary
Health Net Medi-Cal has issued a reminder policy outlining when providers must refer patients for second opinion consults. The policy clarifies that all second opinion care must be authorized by the PPG or PCP to be covered, and separate approvals are needed for additional tests beyond the consultation.
Action Required
Immediately: Ensure all second opinion referrals are properly authorized by the participating physician group (PPG) or primary care physician (PCP) before scheduling. Billing team must verify separate authorization for any additional tests, lab work, or x-ray services ordered during second opinion consults. Results must be sent back to the referring PPG or PCP for care coordination to ensure coverage.