MedicaidPrior AuthMedium impact
20-092 Prior Authorization Requirements
Health Net·CA · Endocrinology, Gastroenterology, General Surgery +1 more·Prior Authorization
Effective date
Apr 1, 2020
We identified it
Jun 20, 2026
Summary
Health Net is implementing new prior authorization requirements for Medi-Cal FFS providers in Fresno, Kings and Madera counties effective April 1, 2020. New PA requirements include continuous glucose monitoring for adults 21+, H. pylori antibody testing, HLA typing for transplants, and 8 specific outpatient pharmaceuticals including Aliqopa and Beouvu.
Action Required
Immediately: Billing team must update prior authorization workflows for Medi-Cal FFS patients in Fresno, Kings and Madera counties. Require PA for continuous glucose monitoring (adults 21+), H. pylori antibody testing, transplant HLA typing, and outpatient pharmaceuticals: Aliqopa, azedra, Beouvu, Besponsa, Folotyn, Kanuma, Lutathera, Polivy. Verify PA requirements at provider.healthnet.com before submitting claims. Claims without required PA will be denied.