CommercialCoverageMedium impact
20-930 Give Timely Flu Shots to Help Keep Members Healthy
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net reminds providers that flu vaccines are a covered benefit without prior authorization, precertification, or cost-sharing for all members. Providers can bill for both the flu vaccine itself and administration, with delegated PPGs required to cover costs even for out-of-network referrals during COVID-19 emergency.
Action Required
Immediately: Ensure billing team processes flu vaccine claims without requiring prior authorization or precertification. Update billing workflows to allow claims for both vaccine product and administration. For Medi-Cal pediatric patients, bill only administration (vaccine provided free through VFC program). Delegated PPGs must arrange coverage for out-of-network flu vaccine costs during COVID emergency.