MedicaidPrior AuthHigh impact
26-953 PCS Form Required to Authorize NEMT Services for Medi-Cal Members
Health Net·CA·Prior Authorization
We identified it
Aug 1, 2026
Summary
Health Net Medi-Cal now requires a completed and signed Physician Certification Statement (PCS) form for all Non-Emergency Medical Transportation (NEMT) services including wheelchair vans, gurney/stretcher vans, ambulances (all levels), and air transport. Missing or incomplete forms will result in authorization delays or denials. Authorizations are valid for up to 12 months and must be resubmitted if services continue.
Action Required
Immediately: Billing team and providers must implement PCS form requirement for all Medi-Cal NEMT authorization requests in the 10 affected California counties (Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare, Tuolumne). SPECIFIC ACTIONS: (1) Download PCS HN Form from Medi-Cal Provider Library and distribute to all providers and practitioner groups; (2) Update prior authorization workflows to require completed, signed PCS form before scheduling any NEMT service; (3) Configure billing system to flag NEMT claims without PCS form documentation; (4) Establish fax submission process to Health Net Care Ride Unit (833-701-0-0051) for all PCS forms; (5) Create 12-month tracking system for authorization expiration dates and prompt resubmission of new PCS forms when medical necessity reassessment is required; (6) Train all front desk, clinical, and billing staff on new requirement. WHO: Billing team (workflow setup), Providers/Practitioners (form completion and signature), Administrative staff (form submission and tracking). CONSEQUENCES: Claims will be denied and services will not be authorized without completed PCS form submission prior to transportation scheduling.