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20-494 View Medical Necessity Guidelines for Paclitaxel Online in Four Steps or Less
Health Net·CA · Oncology, Hematology·Reimbursement
Effective date
Feb 14, 2020
We identified it
Jun 20, 2026
Summary
Health Net has implemented new medical necessity guidelines for paclitaxel (Abraxane®) that require specific criteria to be met for reimbursement. Claims submitted outside these medical necessity guidelines will be denied, with the policy applying to claims for dates of service after February 14, 2020.
Action Required
Immediately: Billing team must access Health Net's Provider Library to review policy CP.PHAR.176 for Paclitaxel (Abraxane) medical necessity criteria. Ensure all Abraxane claims meet the documented medical necessity guidelines before submission. Providers must document that patients meet the specific criteria outlined in the policy. Claims not meeting these guidelines will be denied.