MedicaidPrior AuthMedium impact
20-560 Review New Requirement for Private Duty Nursing for Medi-Cal Members Under Age 21
Health Net·CA · Pediatrics, Family Medicine·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net Medi-Cal now requires prior authorization for all Private Duty Nursing (PDN) services for members under age 21, with mandatory case management referrals. This applies to specific California counties and requires providers to submit authorization requests through their PPG or directly to Health Net.
Action Required
Immediately: Billing team must obtain prior authorization for all Private Duty Nursing services for Medi-Cal members under age 21. Submit requests through PPG's process or complete Health Net's Request for Prior Authorization form and fax to 1-800-743-1655. Providers must submit case management referrals to CASHP.ACM.CMA@healthnet.com or fax to 1-866-581-0540 for all members under 21 receiving PDN services. Update billing system to flag these cases for prior auth requirements.