MedicaidPrior AuthMedium impact
20-542 Behavioral Health Screening Referrals
Health Net·CA · Family Medicine, Internal Medicine, General Practice +2 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net Cal MediConnect (Medicare-Medicaid Plan) has updated their behavioral health screening and referral policy, specifying recommended screening tools (GAD-7, PHQ-9, PC-PTSD-5) for PCPs and clarifying that prior authorization is NOT required for initial outpatient behavioral health assessments. Members can self-refer to MHN services without PCP referral, and specific timeframes are established for different types of behavioral health services.
Action Required
Immediately: Billing team should verify that initial outpatient behavioral health assessment claims do not require prior authorization for Health Net Cal MediConnect members. Update staff training to inform providers that these members can self-refer to MHN services. Ensure signed Authorization for Disclosure of Protected Health Information forms are obtained and kept in medical records when coordinating with MHN services.