MedicaidPrior AuthHigh impact
26-875sum Summary Update: Updates to Prior Authorization Requirements
Health Net·CA·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jul 28, 2026
Summary
Community Health Plan of Imperial Valley (CHPIV) is updating prior authorization requirements for Medi-Cal beneficiaries in Imperial County with three separate effective dates: July 1, 2026, July 28, 2026, and October 1, 2026. Billing teams must review the complete policy document (26-875) to identify which specific services require new or modified prior authorization and implement changes by each effective date to avoid claim denials.
Action Required
By July 1, 2026: Billing team and providers must access the complete Policy 26-875 update from the Provider Library (Medi-Cal > Updates and Notices) and extract the specific code lists showing which services require prior authorization. Update billing software and encounter forms to reflect all new PA requirements effective July 1, 2026. By July 28, 2026: Implement any additional PA requirement changes effective on this date. By October 1, 2026: Apply final round of PA additions and removals. Before submitting any PA requests: Verify member eligibility and benefits for all Medi-Cal beneficiaries in Imperial County. Beginning July 1, 2026: Submit prior authorization requests for all applicable services per the updated requirements. Note: Authorization requirements are independent of coverage determinations—changes to PA do not guarantee benefit coverage. Failure to obtain required prior authorization will result in claim denials.