MedicaidPrior AuthMedium impact
20-090 Prior Authorization Requirements
Health Net·CA · Endocrinology, General Surgery, Nephrology·Prior Authorization
Effective date
Apr 1, 2020
We identified it
Jun 20, 2026
Summary
Health Net is implementing changes to Cal MediConnect Plan (Medicare-Medicaid Plan) prior authorization requirements effective April 1, 2020. Continuous glucose monitoring now requires prior auth under DME, HLA typing has been added to transplant requirements, and all transplants must be performed through Health Net's designated specialty network.
Action Required
Immediately: Billing team must update prior authorization workflows for Cal MediConnect Plan members. Add prior auth requirements for continuous glucose monitoring under DME category. Add HLA typing to transplant prior authorization requirements. Verify all transplant procedures are scheduled through Health Net's designated transplantation specialty network. Access provider.healthnet.com to review complete prior authorization requirements list and update billing system rules accordingly.