Medicare AdvantageDocumentationMedium impact
20-117 Refer to Updated PCS Form to Authorize Transport for Patients
Health Net·CA·Provider News
We identified it
Jun 20, 2026
Summary
Health Net Cal MediConnect Plan requires providers to use an updated Physician Certification Statement (PCS) form when requesting non-medical transportation (NMT) or non-emergency medical transportation (NEMT) for Medicare-Medicaid enrollees. The form must document specific medical limitations that prevent patients from using public or private transportation.
Action Required
Immediately: All providers (MDs, RNs, NPs, PCPs, LVNs, PAs, and discharge planners) must begin using the updated PCS form for Health Net Cal MediConnect Plan enrollees needing transportation services. Download the new form from provider.healthnet.com by navigating to Provider Library > Working with Health Net > Contractual > Policy Library > Operations Manuals > Benefits > Transportation > Physician Certification Statement (PCS) Form. Document specific physical and medical limitations that prevent patient from using public/private transportation. Failure to use updated form may result in transportation authorization delays or denials.