MedicaidPrior AuthHigh impact
26-956 Provider Communications Posted Online and Operations Manual Updates for July 2026
Health Net·CA · OB-GYN, Palliative Care·Prior Authorization
Effective date
Jul 9, 2026
We identified it
Aug 8, 2026
Summary
This July 2026 policy update consolidates multiple operational changes across Health Net California's provider manual, with the most critical change being that long-term care prior authorization requests for Medi-Cal must now be submitted by fax only (effective July 9, 2026) rather than email. Additionally, hospice prior authorization documentation requirements have been revised, encounter data submission requirements have been updated for Medi-Cal capitated providers, and maternity/perinatal services billing guidance has been clarified.
Action Required
By July 9, 2026: (1) Billing team must stop submitting long-term care prior authorization requests via email for Medi-Cal and switch to fax-only submission using the updated Long-Term Care Authorization Notification Form. Update internal workflows, templates, and provider alerts accordingly. Fax submissions are now the only accepted method; email submissions will not be processed. (2) By July 21, 2026: Update hospice care prior authorization processes to reflect new documentation requirements outlined in the updated Hospice Services Documentation Guide. Ensure all hospice PA requests include revised required documentation. (3) By July 21, 2026: For capitated Medi-Cal providers (professional and institutional), review and ensure compliance with updated QMED 2.0 encounter data submission requirements, emphasizing timely, accurate, and complete submission. Non-compliance may result in denials. (4) By July 6, 2026: Update maternity billing protocols to align with CPSP requirements and prenatal screening billing per DHCS All Plan Letter 6-005. Billing team should verify system configurations for these covered services.