26-1058 Provider Communication Posted Online and Operations Manual Updates for August 2026

By August 31, 2026: Billing team must access the updated 'Services Not Requiring Prior Authorization' document in the Provider Operations Manual (under Prior Authorization section) and implement changes to billing system rules and prior authorization workflows. Specifically: (1) Review and document which hospice, behavioral health, maternal health, and preventive services no longer require prior authorization; (2) Update billing system to remove prior authorization requirements for identified services to prevent unnecessary claim delays and denials; (3) Brief providers and front desk staff on services exempt from prior authorization to improve claim processing efficiency; (4) Audit recent claims for these service categories to identify any unnecessary prior authorization requests that may have caused payment delays. Failure to implement these changes may result in unnecessary claim holds and processing delays. Additionally, by August 4, 2026: Providers should stop requiring cognitive health assessment training documentation per DHCS APL 26-014 alignment, though existing assessment and billing requirements remain. By August 11, 2026: Verify claims payment processing for Medi-Cal Prohibited Entities reflects updated guidelines following the H.R. 1 federal payment restriction end date (July 4, 2026). By August 21, 2026: Ensure front desk and billing staff do not charge Medi-Cal members for form completion or information requests related to public benefits eligibility, though medical record copy fees may still apply per California law.