MedicaidPrior AuthHigh impact
26-959 Provider Communications Posted Online and Operations Manual Updates for July 2026
Health Net·CA·Prior Authorization
Effective date
Jul 9, 2026
We identified it
Aug 8, 2026
Summary
This is a July 2026 provider communications and operations manual update affecting Medi-Cal in Fresno, Kings, and Madera counties. Critical changes include: (1) Long-term care prior authorization requests must now be submitted by fax only (effective 7/9/26), (2) Encounter data submission requirements updated for quality measures compliance, and (3) Hospice care documentation and prior authorization requirements revised with a new Hospice Services Documentation Guide.
Action Required
REQUIREMENTS: By July 9, 2026: Billing team must immediately halt email submissions for long-term care prior authorization requests and transition to fax-only submission using the updated Long-Term Care Authorization Notification Form. Update internal workflows, provider communications, and billing system routing rules to enforce fax-only submission. Non-compliance will result in claim denials and authorization delays. Additionally, by July 21, 2026: Billing team must review and implement updated Hospice Care documentation requirements, including revised prior authorization submission documentation and the new Hospice Services Documentation Guide (PDF). Update hospice claim submission processes and prior auth templates in billing system. For all encounter data submissions (effective 7/21/26): Ensure capitated providers understand timely, accurate, and complete encounter data submission requirements under QMED 2.0 standards; audit current submission processes for compliance. Review updated Benefits > Maternity sections for CPSP billing changes effective 7/6/26 and ensure prenatal screening and required services are billed per new guidelines.